Individual
DR. JOSEPH DIFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
107 MONMOUTH RD, SUITE 101, WEST LONG BRANCH, NJ 07764-1000
(732) 542-0011
(732) 542-9419
Mailing address
107 MONMOUTH RD, SUITE 101, WEST LONG BRANCH, NJ 07764-1000
(732) 542-0011
(732) 542-9419
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
22DI01294600
NJ
1223P0700X
Prosthodontics
Primary
3161
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1160430
—
NJ
Enumeration date
02/22/2007
Last updated
07/08/2007
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