Provider Demographics
NPI:1215112552
Name:MIRRIONE, JOHN J (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MIRRIONE
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 1:900 ROUTE 168 STE C5
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3206
Mailing Address - Country:US
Mailing Address - Phone:856-401-8800
Mailing Address - Fax:856-401-8840
Practice Address - Street 1:900 ROUTE 168 STE C5
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3206
Practice Address - Country:US
Practice Address - Phone:856-401-8800
Practice Address - Fax:856-401-8840
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0165891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice