Provider Demographics
NPI:1811132442
Name:CARUSO, EDMUND MARIO (DMD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:MARIO
Last Name:CARUSO
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 1:2275 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1527
Mailing Address - Country:US
Mailing Address - Phone:201-434-3819
Mailing Address - Fax:201-434-3865
Practice Address - Street 1:2275 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1527
Practice Address - Country:US
Practice Address - Phone:201-434-3819
Practice Address - Fax:201-434-3865
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI156981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice