Organization
CHILDREN'S DENTAL SURGERY CENTER OF JACKSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHI LE (CREDENTIALING CONTRACTS MANAGER)
(267) 575-2321
Entity
Organization
Contact information
Practice address
27 S COOKS BRIDGE RD STE L-2, JACKSON, NJ 08527-2461
(732) 928-1099
Mailing address
300 WILLOWBROOK LN STE 330, WEST CHESTER, PA 19382-5594
(267) 575-2321
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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