Provider Demographics
NPI:1942558754
Name:MEHLMAN, MARC (DMD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MEHLMAN
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 1:613 HOPE RD
Mailing Address - Street 2:BLDG. 5
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1278
Mailing Address - Country:US
Mailing Address - Phone:732-542-4433
Mailing Address - Fax:732-389-0304
Practice Address - Street 1:613 HOPE RD
Practice Address - Street 2:BLDG. 5
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1278
Practice Address - Country:US
Practice Address - Phone:732-542-4433
Practice Address - Fax:732-389-0304
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist