MEDICARE: DENTAL ASSOCIATES AT PITMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D19515	NJ
2	1223G0001X	General Practice Dentistry	D24083	NJ
3	1223G0001X	General Practice Dentistry	D23996	NJ
4	1223G0001X	General Practice Dentistry	D14419	NJ

General Provider Information

NPI Number	:	1033497920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL ASSOCIATES AT PITMAN

Provider Business Mailing Address
First Line	:	410 N BROADWAY
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071-1047
Country	:	US
Telephone Number	:	856-589-3803
Fax Number	:	856-589-0371

Provider Business Practice Location Address
First Line	:	410 N BROADWAY
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071-1047
Country	:	US
Telephone Number	:	856-589-3803
Fax Number	:	856-589-0371

Authorized Official
Title or Position	:	BILLING/INSURANCE COORDINATOR
Name	:	MRS. VALERIE A BURGER
Credential	:
Telephone Number	:	856-589-3803

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	07/27/2011

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Directions to “DENTAL ASSOCIATES AT PITMAN ” Practice Location

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