Provider Demographics
NPI:1366518763
Name:VOYTUS, MARY L (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:VOYTUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BAY AVE
Mailing Address - Street 2:MOUNTAINSIDE HOSPITAL
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4837
Mailing Address - Country:US
Mailing Address - Phone:973-429-6889
Mailing Address - Fax:973-680-7809
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:MOUNTAINSIDE HOSPITAL
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4837
Practice Address - Country:US
Practice Address - Phone:973-429-6889
Practice Address - Fax:973-680-7809
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 129351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU44441Medicare UPIN
NJ5008905Medicaid
NJD8G052Medicare ID - Type Unspecified