Provider Demographics
NPI:1528060415
Name:ARROWHEAD FAMILY DENTAL PA
Entity type:Organization
Organization Name:ARROWHEAD FAMILY DENTAL PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER / RDA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VITTONE
Authorized Official - Suffix:
Authorized Official - Credentials:RDA, OM, CDA
Authorized Official - Phone:732-840-1300
Mailing Address - Street 1:2024 ROUTE 88 E
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3226
Mailing Address - Country:US
Mailing Address - Phone:732-840-1300
Mailing Address - Fax:732-840-3840
Practice Address - Street 1:2024 ROUTE 88 E
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3226
Practice Address - Country:US
Practice Address - Phone:732-840-1300
Practice Address - Fax:732-840-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ182121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty