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Provider Information for 1891904272

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1891904272

Calendar   Last Updated:  2007-08-01
  Certification Date: 


Name Value
NPI 1891904272
Enumeration Date 2007-05-22
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 429 GARDEN STATE DR
CHERRY HILL, NJ 08002-1917
United States

Phone: 856-665-1534 | Fax: 856-665-1534
View Map External Link
Primary Practice Address 1401 MARLTON PIKE W
CHERRY HILL, NJ 08002-3731
United States

Phone: 856-616-9191 | Fax: 856-616-9119
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice NJ 12322