Provider Demographics
NPI:1801912647
Name:HOLLY BEACH DENTAL ASSOCIATES
Entity type:Organization
Organization Name:HOLLY BEACH DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSCALDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-522-1471
Mailing Address - Street 1:4301 NEW JERSEY AVE
Mailing Address - Street 2:PO BOX 1326
Mailing Address - City:WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-1824
Mailing Address - Country:US
Mailing Address - Phone:609-522-1471
Mailing Address - Fax:609-522-5473
Practice Address - Street 1:4301 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-1824
Practice Address - Country:US
Practice Address - Phone:609-522-1471
Practice Address - Fax:609-522-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty