Organization
NJ DENTISTRY FOR CHILDREN, P.A.
Active
Other names
Dentistry For Children, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
VAN PHI LE (CREDENTIALING MANAGER)
(484) 787-2946
Entity
Organization
Contact information
Practice address
870 RIVER AVE, LAKEWOOD, NJ 08701-5220
(732) 240-3355
Mailing address
200 WILLOWBROOK LN STE 220, WEST CHESTER, PA 19382-5697
(610) 500-2042
(610) 884-6296
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10202
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2859009
—
NJ
05
—
3618901
—
NJ
Enumeration date
10/09/2008
Last updated
02/21/2020
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