# WOODBINE DENTAL PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700919594
- **Authorized official:** JACQUES NATHAN DDS (DENTIST PRESIDENT)
- **Authorized official phone:** (609) 861-2784

## Contact information

- **Practice address:** 901 DEHIRSCH AVENUE, WOODBINE, NJ 08270
- **Practice address phone:** (609) 861-2784
- **Practice address fax:** (609) 861-3160
- **Mailing address:** 901 DEHIRSCH AVENUE, WOODBINE, NJ 08270
- **Mailing address phone:** (609) 861-2784
- **Mailing address fax:** (609) 861-3160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22DI00879400 | NJ | — |
| 122300000X | Dentist | 22DI01862600 | NJ | — |
| 122300000X | Dentist | 22DI01877400 | NJ | Yes |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2743906 | — | NJ |