Provider Demographics
NPI:1184724965
Name:ATLANTIC DENTAL
Entity type:Organization
Organization Name:ATLANTIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-557-5500
Mailing Address - Street 1:171 ROUTE 37 EAST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5502
Mailing Address - Country:US
Mailing Address - Phone:732-557-5500
Mailing Address - Fax:732-557-5300
Practice Address - Street 1:171 ROUTE 37 EAST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-5502
Practice Address - Country:US
Practice Address - Phone:732-557-5500
Practice Address - Fax:732-557-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID NUMBER