Individual
DR. PETER A DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
279 3RD AVE, SUITE 303, LONG BRANCH, NJ 07740-6205
(732) 222-1533
(732) 222-7715
Mailing address
279 3RD AVE, SUITE 303, LONG BRANCH, NJ 07740-6205
(732) 222-1533
(732) 222-7715
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17239
NJ
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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