Healthcare Provider Details

I. General information

NPI: 1336213065
Provider Name (Legal Business Name): EXCLUSIVELY ENDODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 04/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 KINGS HWY S STE 3A
CHERRY HILL NJ
08034
US

IV. Provider business mailing address

401 KINGS HWY S STE 3A
CHERRY HILL NJ
08034
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-7811
  • Fax: 856-216-8194
Mailing address:
  • Phone: 856-429-7811
  • Fax: 856-216-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: BENEDICT BACHSTEIN I
Title or Position: OWNER
Credential: DMD
Phone: 856-429-7811