Healthcare Provider Details

I. General information

NPI: 1457916223
Provider Name (Legal Business Name): COLLINGSWOOD DENTAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 HADDON AVE
COLLINGSWOOD NJ
08108-1923
US

IV. Provider business mailing address

630 W GERMANTOWN PIKE STE 120
PLYMOUTH MEETING PA
19462-1074
US

V. Phone/Fax

Practice location:
  • Phone: 856-854-5543
  • Fax:
Mailing address:
  • Phone: 484-455-4545
  • Fax: 484-284-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN HILL
Title or Position: RCM, DIRECTOR
Credential:
Phone: 972-930-7707