Provider Demographics
NPI:1649339060
Name:CANCELLIERI, FRANK BENJAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:BENJAMIN
Last Name:CANCELLIERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 COLTS NECK ROAD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8108
Mailing Address - Country:US
Mailing Address - Phone:732-431-5678
Mailing Address - Fax:732-431-5678
Practice Address - Street 1:BOX 866 RANGE RD
Practice Address - Street 2:MID STATE CORRECTIONAL FACILITY CMS MEDICAL
Practice Address - City:WRIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08562
Practice Address - Country:US
Practice Address - Phone:609-724-9139
Practice Address - Fax:609-724-9124
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D100875200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist