Provider Demographics
NPI:1215951546
Name:KANTROWITZ, MARK ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:KANTROWITZ
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 1:451 PALISADE AVE
Mailing Address - Street 2:PO BOX 277
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2825
Mailing Address - Country:US
Mailing Address - Phone:201-945-0970
Mailing Address - Fax:
Practice Address - Street 1:451 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2825
Practice Address - Country:US
Practice Address - Phone:201-945-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011449001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice