Healthcare Provider Details

I. General information

NPI: 1760800346
Provider Name (Legal Business Name): PENNS GROVE FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W MAIN ST
PENNS GROVE NJ
08069-1348
US

IV. Provider business mailing address

31 W MAIN ST
PENNS GROVE NJ
08069-1348
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-1096
  • Fax:
Mailing address:
  • Phone: 856-299-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. SYLVAN GARFUNKEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-299-1096