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Individual

DR. PHYLLIS HORNING DETWILER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
110 MARTER AVE, SUITE 204, MOORESTOWN, NJ 08057-3124
(856) 727-6453
(856) 727-4039
Mailing address
113 N BREAD ST, APARTMENT 2B, PHILADELPHIA, PA 19106-4610
(732) 567-6333

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI01130400
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
22DI011130400
DENTAL LICENSE
NJ
Enumeration date
05/23/2005
Last updated
01/03/2015
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