Provider Demographics
NPI:1336348168
Name:NESTER, MARK W (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:NESTER
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 1:511 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1574
Mailing Address - Country:US
Mailing Address - Phone:856-845-7397
Mailing Address - Fax:
Practice Address - Street 1:200 E MANTUA AVE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1921
Practice Address - Country:US
Practice Address - Phone:856-468-5858
Practice Address - Fax:856-468-9098
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ164171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1225096712OtherASSOCIATE
NJ1255365235OtherPARTNER
NJ1306049259OtherPRACTICE