Provider Demographics
NPI:1912011230
Name:COLONIA DENTAL GROUP
Entity Type:Organization
Organization Name:COLONIA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CENNAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-381-7171
Mailing Address - Street 1:422 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3717
Mailing Address - Country:US
Mailing Address - Phone:732-381-7171
Mailing Address - Fax:732-499-7958
Practice Address - Street 1:422 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3717
Practice Address - Country:US
Practice Address - Phone:732-381-7171
Practice Address - Fax:732-499-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0129651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty