Provider Demographics
NPI:1528125689
Name:MOGLIANESI, CARLOS (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:MOGLIANESI
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 1:1806 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1005
Mailing Address - Country:US
Mailing Address - Phone:908-665-2300
Mailing Address - Fax:908-665-9299
Practice Address - Street 1:1806 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1005
Practice Address - Country:US
Practice Address - Phone:908-665-2300
Practice Address - Fax:908-665-9299
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ151751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics