Provider Demographics
NPI:1184708505
Name:MENZA, VITO (DMD)
Entity type:Individual
Prefix:MR
First Name:VITO
Middle Name:
Last Name:MENZA
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 1:776 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3224
Mailing Address - Country:US
Mailing Address - Phone:732-738-1551
Mailing Address - Fax:732-738-4430
Practice Address - Street 1:776 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3224
Practice Address - Country:US
Practice Address - Phone:732-738-1551
Practice Address - Fax:732-738-4430
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI130671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice