Individual
DR. CARL ANGELO BIFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2 PLAZA DR STE 202, SEWELL, NJ 08080
(856) 270-4100
Mailing address
1 FEDERAL ST STE SW200, CAMDEN, NJ 08103-1155
(856) 356-4924
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
6833
MD
1223P0106X
Oral and Maxillofacial Pathology Dentistry
DI02457900
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS019214L
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
22D102457901
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025303770001
—
PA
01
—
DI02457900
STATE LICENSE
NJ
01
—
DS019214L
LICENSE
PA
Enumeration date
05/05/2006
Last updated
04/01/2019
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