Provider Demographics
NPI:1215158076
Name:DURANTE, MARK (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DURANTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 SPRINGFIELD AVENUE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922
Mailing Address - Country:US
Mailing Address - Phone:908-464-4664
Mailing Address - Fax:908-464-8215
Practice Address - Street 1:261 SPRINGFIELD AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922
Practice Address - Country:US
Practice Address - Phone:908-464-4664
Practice Address - Fax:908-464-8215
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013816001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ503397Medicare PIN