Provider Demographics
NPI:1952686560
Name:MOUNTAIN TOP DENTAL
Entity Type:Organization
Organization Name:MOUNTAIN TOP DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-831-3742
Mailing Address - Street 1:1 CEDAR CREST DR
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-2100
Mailing Address - Country:US
Mailing Address - Phone:973-831-3742
Mailing Address - Fax:
Practice Address - Street 1:1 CEDAR CREST DR
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-2100
Practice Address - Country:US
Practice Address - Phone:973-831-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1014871001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty