Healthcare Provider Details

I. General information

NPI: 1063406403
Provider Name (Legal Business Name): SUSAN ADELE ARMSTRONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E MAIN ST
MOORESTOWN NJ
08057-3382
US

IV. Provider business mailing address

9 E MAIN ST
MOORESTOWN NJ
08057-3382
US

V. Phone/Fax

Practice location:
  • Phone: 856-235-0415
  • Fax: 856-235-4787
Mailing address:
  • Phone: 856-235-0415
  • Fax: 856-235-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS036117
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02197700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: