Provider Demographics
NPI:1922121250
Name:MASTROBATTISTA, SAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:MASTROBATTISTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 GREENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-2435
Mailing Address - Country:US
Mailing Address - Phone:908-528-7000
Mailing Address - Fax:908-735-6651
Practice Address - Street 1:1484 ROUTE 31 NORTH
Practice Address - Street 2:WALNUT POND PROFESSIONAL BUILDING
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809
Practice Address - Country:US
Practice Address - Phone:908-528-7000
Practice Address - Fax:908-735-6651
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice