Provider Demographics
NPI:1780814129
Name:BUONGIOVANNI, GEORGE (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BUONGIOVANNI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 WHARTON ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5299
Mailing Address - Country:US
Mailing Address - Phone:609-638-1192
Mailing Address - Fax:856-985-7761
Practice Address - Street 1:1508 WHARTON ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-5299
Practice Address - Country:US
Practice Address - Phone:609-638-1192
Practice Address - Fax:856-985-7761
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI13193001223G0001X
NJ22DI01319300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist