Provider Demographics
NPI:1750766358
Name:ARAMPHONGPHAN, TANEENOP (DMD)
Entity type:Individual
Prefix:DR
First Name:TANEENOP
Middle Name:
Last Name:ARAMPHONGPHAN
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 1:58 MOUNT BETHEL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2655
Mailing Address - Country:US
Mailing Address - Phone:908-222-7922
Mailing Address - Fax:908-222-7923
Practice Address - Street 1:58 MOUNT BETHEL RD STE 202
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2655
Practice Address - Country:US
Practice Address - Phone:908-222-7922
Practice Address - Fax:908-222-7923
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027558001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty