Organization
DENTRUST DENTAL, P.A.
Active
Other names
Docs Dental Joint Base McGuire Dix Lakehurst
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA A CLARK (DIRECTOR OF CREDENTIALING)
(609) 342-6467
Entity
Organization
Contact information
Practice address
3452 BRODY AVE, FT. DIX, NJ 08640
(609) 342-6467
Mailing address
6097 EASTON RD, PIPERSVILLE, PA 18947-1810
(445) 200-8197
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22D101759200
LICENSE NUMBER
NJ
Enumeration date
01/24/2023
Last updated
01/24/2023
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