Healthcare Provider Details

I. General information

NPI: 1821796210
Provider Name (Legal Business Name): BMK DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 ELMWOOD RD N STE H140
MARLTON NJ
08053-2377
US

IV. Provider business mailing address

270 ELMWOOD RD N STE H140
MARLTON NJ
08053-2377
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-6888
  • Fax: 856-446-6662
Mailing address:
  • Phone: 856-291-6888
  • Fax: 856-446-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KRISHNA PATEL
Title or Position: OWNER
Credential: DMD
Phone: 856-291-6888