# KLDDMD1PC

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

## Provider details

- **NPI number:** 1982389359
- **Authorized official:** MS. SUZANNE DEBRA BAALS RDH (MANAGER)
- **Authorized official phone:** (856) 467-1900

## Contact information

- **Practice address:** 1908 KINGS HWY, SWEDESBORO, NJ 08085-1638
- **Practice address phone:** (856) 467-1900
- **Practice address fax:** (856) 467-8435
- **Mailing address:** PO BOX 128, SWEDESBORO, NJ 08085-0128
- **Mailing address phone:** (856) 467-1900
- **Mailing address fax:** (856) 467-8435

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/21/2023
- **Last updated:** 06/21/2023