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Organization
WYCKOFF-NESTER, LLP
Active
Organization
WYCKOFF-NESTER, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL K WYCKOFF III D.D.S. (PARTNER)
(856) 468-5858
Entity
Organization
Contact information
Practice address
200 E MANTUA AVE, WENONAH, NJ 08090-1921
(856) 468-5858
(856) 468-9098
Mailing address
200 E MANTUA AVE, PO BOX 37, WENONAH, NJ 08090-1921
(856) 468-5858
(856) 468-9098
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11728
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225096712
INDIVIDUAL
NJ
01
—
1255365235
INDIVIDUAL
NJ
Enumeration date
06/07/2007
Last updated
08/22/2020
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