Healthcare Provider Details

I. General information

NPI: 1497891188
Provider Name (Legal Business Name): MAINLAND DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2645
US

IV. Provider business mailing address

50 W BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2645
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-1065
  • Fax: 609-645-0162
Mailing address:
  • Phone: 609-641-1065
  • Fax: 609-645-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI01124100
License Number StateNJ

VIII. Authorized Official

Name: DR. IRA MENDELSOHN
Title or Position: OWNER
Credential: DDS
Phone: 609-641-1065