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General NPI Number Information
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NPI Number | 1013257880
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Entity Type | Organization
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Legal Business Name | TEAM DENTAL SWEDESBORO, LLC
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 300 LEXINGTON RD STE 220
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City | SWEDESBORO
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State | NJ
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Zip | 08085-1278
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Country | US
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Telephone | 856-467-4677
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Fax | 856-832-4173
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Provider Business Mailing Address
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Address Line | 300 LEXINGTON RD BUILDING B, SUITE 220
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City | SWEDESBORO
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State | NJ
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Zip | 08085-1278
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Country | US
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Telephone | 856-467-4677
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Fax | 856-832-4173
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MURTUZA JAFFARI
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Credential | DDS
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Telephone | 856-467-4677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI01454700
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License Number State | NJ
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