Provider Demographics
NPI:1336909118
Name:FREDERICK J CARBONE DDS LLC
Entity type:Organization
Organization Name:FREDERICK J CARBONE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-228-0039
Mailing Address - Street 1:157 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1353
Mailing Address - Country:US
Mailing Address - Phone:973-228-0039
Mailing Address - Fax:973-228-9073
Practice Address - Street 1:157 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1353
Practice Address - Country:US
Practice Address - Phone:973-228-0039
Practice Address - Fax:973-228-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619986783OtherNPI FOR FREDERICK J CARBONE DDS
22-2662322OtherTID FOR FREDERICK J CARBONE DDS