| Comprehensive & Cosmetic & General Dististry | |
|
3350 State Route 138 Ste 127 Wall Township NJ 07719-9693 | |
| (732) 556-9600 | |
| (732) 556-9601 |
| Full Name | Comprehensive & Cosmetic & General Dististry |
|---|---|
| Speciality | Dentist |
| Location | 3350 State Route 138, Wall Township, New Jersey |
| Authorized Official Name and Position | Anthony Joseph Mancino (OWNER,PRESIDENT) |
| Authorized Official Contact | 7325569600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Comprehensive & Cosmetic & General Dististry 3350 State Route 138 Ste 127 Wall Township NJ 07719-9693 Ph: (732) 556-9600 | Comprehensive & Cosmetic & General Dististry 3350 State Route 138 Ste 127 Wall Township NJ 07719-9693 Ph: (732) 556-9600 |
| NPI Number | 1104930668 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 05/06/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104930668 | NPI | - | NPPES |
| 11320 | Other | NJ | INS CO'S |
| 90730-00-4 | Other | NJ | NJ EMPLOYER ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 11320 (New Jersey) | Primary |
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