Provider Demographics
NPI:1902943202
Name:WASSERMAN, HARVEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SMALLWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2918
Mailing Address - Country:US
Mailing Address - Phone:732-431-1444
Mailing Address - Fax:732-431-1444
Practice Address - Street 1:1 SMALLWOOD LANE
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-2918
Practice Address - Country:US
Practice Address - Phone:732-431-1444
Practice Address - Fax:732-431-1444
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ79601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice