Provider Demographics
NPI:1992910095
Name:PITEL, MAX ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:ROBERT
Last Name:PITEL
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 1:505 AUBURN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1602
Mailing Address - Country:US
Mailing Address - Phone:856-241-1055
Mailing Address - Fax:856-241-1077
Practice Address - Street 1:505 AUBURN AVE FL 1
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1602
Practice Address - Country:US
Practice Address - Phone:856-241-1055
Practice Address - Fax:856-241-1077
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1022140021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
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