Healthcare Provider Details

I. General information

NPI: 1356941884
Provider Name (Legal Business Name): WEST CREEK DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 S MAIN ST
WEST CREEK NJ
08092-3123
US

IV. Provider business mailing address

524 S MAIN ST
WEST CREEK NJ
08092-3123
US

V. Phone/Fax

Practice location:
  • Phone: 609-597-9290
  • Fax:
Mailing address:
  • Phone: 609-597-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN MARTIN
Title or Position: PRESIDENT
Credential: DMD
Phone: 609-597-9290