Healthcare Provider Details

I. General information

NPI: 1710094230
Provider Name (Legal Business Name): ALPHA DENTAL ASSOCS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 BRANCH PIKE
CINNAMINSON NJ
08077-3044
US

IV. Provider business mailing address

2103 BRANCH PIKE
CINNAMINSON NJ
08077-3044
US

V. Phone/Fax

Practice location:
  • Phone: 856-829-1989
  • Fax: 856-829-5014
Mailing address:
  • Phone: 856-829-1989
  • Fax: 856-829-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER JANE KALOCHIE
Title or Position: DENTIST OWNER
Credential: DMO
Phone: 856-829-1989