Provider Demographics
NPI:1194849968
Name:ALON DENTAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ALON DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF ALON DENTAL ASSOCIATES
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:NOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-358-8303
Mailing Address - Street 1:440 FRONT ST
Mailing Address - Street 2:P.O. BOX 617
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-2177
Mailing Address - Country:US
Mailing Address - Phone:856-358-8303
Mailing Address - Fax:856-358-9145
Practice Address - Street 1:440 FRONT ST
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2177
Practice Address - Country:US
Practice Address - Phone:856-358-8303
Practice Address - Fax:856-358-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0115544001223G0001X
NJ22DI008323001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2651408Medicaid
NJT84893Medicare UPIN
NJ2651408Medicaid