Provider Demographics
NPI:1992122840
Name:FIORENTINI FAMILY DENTAL GROUP LLC
Entity type:Organization
Organization Name:FIORENTINI FAMILY DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBE
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:SEVERINO
Authorized Official - Last Name:FIORENTINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-655-1023
Mailing Address - Street 1:294 APPLEGARTH RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3798
Mailing Address - Country:US
Mailing Address - Phone:609-655-1023
Mailing Address - Fax:
Practice Address - Street 1:294 APPLEGARTH RD
Practice Address - Street 2:SUITE H
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3798
Practice Address - Country:US
Practice Address - Phone:609-655-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013528000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental