Provider Demographics
NPI:1104880863
Name:EGG HARBOR FAMILY DENTAL, PA
Entity type:Organization
Organization Name:EGG HARBOR FAMILY DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBATICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-553-9393
Mailing Address - Street 1:16 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7643
Mailing Address - Country:US
Mailing Address - Phone:732-914-1039
Mailing Address - Fax:
Practice Address - Street 1:3003 ENGLISH CREEK AVE
Practice Address - Street 2:D-11
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4863
Practice Address - Country:US
Practice Address - Phone:609-484-5996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty