Robert Warren Deatrick II, D.D.S
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Brielle, NJ
NPI 1649349481 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1649349481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- 22DI01290600 (NJ)
- Practice address
- 603 Higgins Ave
Brielle, NJ 08730-1427 - Phone
- (732) 528-5200
- Fax
- (732) 528-7346
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paonessa Colon and Rectal Surgery, P.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 22DI01290600 | NJ | Yes |
Addresses
Primary practice location
603 Higgins Ave
Brielle, NJ 08730-1427
Mailing address
603 Higgins Ave
Brielle, NJ 08730-1427
Phone (732) 528-5200
Other providers in Brielle, NJ
- Caroline Burns
- Sydney Coleman
- Complete Diagnostic & Medical Center of NJ PC
- Lauren Cozzolino
- David I Kleinfeld, MD, PA
- Johannes H Dejong
- Patrick F Donnelly
- DRS Tumas PC
- Nicolette Evans
- Ilan Gamburg
All providers in Brielle, NJ · Oral and Maxillofacial Surgery (Dentist) in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.