Provider Demographics
NPI:1609012533
Name:MEZZA, ALFRED J
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:J
Last Name:MEZZA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ALFRED
Other - Middle Name:J
Other - Last Name:MEZZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:14 PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5015
Mailing Address - Country:US
Mailing Address - Phone:973-839-8087
Mailing Address - Fax:973-839-2673
Practice Address - Street 1:14 PONTIAC DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5015
Practice Address - Country:US
Practice Address - Phone:973-839-8087
Practice Address - Fax:973-839-2673
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI008924001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry