Individual
MS. MARISSA ANNE FANELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
741 BROADWAY, NEWARK, NJ 07104-4309
(973) 483-1300
(973) 483-3787
Mailing address
430 EDGEWOOD PL, RUTHERFORD, NJ 07070-2662
(201) 562-8844
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
22HI00901200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22HI00901200
RDH LICENSE NUMBER
NJ
Enumeration date
12/19/2011
Last updated
12/19/2011
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