Provider Demographics
NPI:1740505908
Name:IN-HOUSE DENTAL SERVICES
Entity type:Organization
Organization Name:IN-HOUSE DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-363-1411
Mailing Address - Street 1:24 LEONE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527
Mailing Address - Country:US
Mailing Address - Phone:732-363-1411
Mailing Address - Fax:732-363-1401
Practice Address - Street 1:975 BENNETTS MILLS RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2225
Practice Address - Country:US
Practice Address - Phone:732-363-1411
Practice Address - Fax:732-363-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19441310400000X
NJDI02081701310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0047899Medicaid
NJ0047911Medicaid