Organization
SOUTHJERSEYDENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KOSHA SHAH (MANAGER)
(856) 240-0406
Entity
Organization
Contact information
Practice address
368 S WHITE HORSE PIKE, BERLIN, NJ 08009-1954
(856) 240-0406
Mailing address
368 S WHITE HORSE PIKE, BERLIN, NJ 08009-1954
(856) 240-0406
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
22DI02287500
NJ
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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