Provider Demographics
NPI:1356840672
Name:DEMIRTAS, FERDA
Entity type:Individual
Prefix:
First Name:FERDA
Middle Name:
Last Name:DEMIRTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LAURELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3648
Mailing Address - Country:US
Mailing Address - Phone:732-678-8952
Mailing Address - Fax:
Practice Address - Street 1:240 HALF MILE RD STE 1
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5684
Practice Address - Country:US
Practice Address - Phone:732-747-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI01124600124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist