Provider Demographics
NPI:1538376462
Name:FALIVENE AND FALIVENE DDS PA
Entity type:Organization
Organization Name:FALIVENE AND FALIVENE DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FALIVENE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-222-4694
Mailing Address - Street 1:232 NORWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1860
Mailing Address - Country:US
Mailing Address - Phone:732-222-4694
Mailing Address - Fax:732-222-1097
Practice Address - Street 1:232 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-222-4694
Practice Address - Fax:732-222-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI006331001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122920601Medicaid