Provider Demographics
NPI:1942408018
Name:HAEMMERLE, MARLIESE CLARE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARLIESE
Middle Name:CLARE
Last Name:HAEMMERLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARLIESE
Other - Middle Name:CLARE
Other - Last Name:IDELBERGER-HAEMMERLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:845 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1037
Mailing Address - Country:US
Mailing Address - Phone:201-945-7052
Mailing Address - Fax:
Practice Address - Street 1:845 BROAD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1037
Practice Address - Country:US
Practice Address - Phone:201-945-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01405700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist