Provider Demographics
NPI:1255743159
Name:SERRATELLI, DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SERRATELLI
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 1:306 ALEXANDER WAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2502
Mailing Address - Country:US
Mailing Address - Phone:862-432-3651
Mailing Address - Fax:
Practice Address - Street 1:942 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3026
Practice Address - Country:US
Practice Address - Phone:201-339-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02593601122300000X
NJ22DI02593602122300000X
NJ22DI02593600122300000X
NJ22DI02593603122300000X
NJ22DA00799207L00000X
NJ070071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology