Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22DI01516600 | NJ |
NPI | 1013161553 |
---|---|
Provider Name | Dr. George Thomas Favetta JR. |
First Address | Martinsville, NJ 08836-2037 |
Second Address | Martinsville, NJ 08836-2037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 11/11/2008 |