# DR MICHAEL J CISAR, DMD & DR WILLIAM L DERRICKSON, DMD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689885345
- **Authorized official:** DR. MICHAEL J CISAR (DENTIST)
- **Authorized official phone:** (732) 842-6300

## Contact information

- **Practice address:** 709 SYCAMORE AVE, TINTON FALLS, NJ 07701-4946
- **Practice address phone:** (732) 842-6300
- **Practice address fax:** (732) 842-3467
- **Mailing address:** 709 SYCAMORE AVE, TINTON FALLS, NJ 07701-4946
- **Mailing address phone:** (732) 842-6300
- **Mailing address fax:** (732) 842-3467

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DI21287 | NJ | Yes |

## Other

- **Enumeration date:** 05/24/2007
- **Last updated:** 08/22/2020