Provider Demographics
NPI:1386793081
Name:ELLIOT M. ALTMAN, DDS & VICTOR J. BUCCELLATO,DMD,PA
Entity type:Organization
Organization Name:ELLIOT M. ALTMAN, DDS & VICTOR J. BUCCELLATO,DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-462-0021
Mailing Address - Street 1:507 STILLWELLS CORNER RD.
Mailing Address - Street 2:STE D
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-462-0021
Mailing Address - Fax:732-462-1602
Practice Address - Street 1:507 STILLWELLS CORNER RD.
Practice Address - Street 2:STE D
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-462-0021
Practice Address - Fax:732-462-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty