Healthcare Provider Details

I. General information

NPI: 1104847805
Provider Name (Legal Business Name): SOMERDALE FAMILY DENTAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N WHITE HORSE PIKE
SOMERDALE NJ
08083-1646
US

IV. Provider business mailing address

205 N WHITE HORSE PIKE
SOMERDALE NJ
08083-1646
US

V. Phone/Fax

Practice location:
  • Phone: 856-783-3499
  • Fax: 856-783-9582
Mailing address:
  • Phone: 856-783-3499
  • Fax: 856-783-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13496
License Number StateNJ

VIII. Authorized Official

Name: DR. FRANCINE J REBHUN
Title or Position: SECRETARY
Credential: DMD
Phone: 856-783-3499