Provider Demographics
NPI:1104642669
Name:TINY TEETH OF LAKEWOOD PC
Entity type:Organization
Organization Name:TINY TEETH OF LAKEWOOD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTACCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:848-245-0779
Mailing Address - Street 1:1000 ROUTE 70 STE 8
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5961
Mailing Address - Country:US
Mailing Address - Phone:848-245-0779
Mailing Address - Fax:848-245-0780
Practice Address - Street 1:1000 ROUTE 70 STE 8
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5961
Practice Address - Country:US
Practice Address - Phone:848-245-0779
Practice Address - Fax:848-245-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty