=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063613602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN M MELTZER DMD, M.SC.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2007
-----------------------------------------------------
Last Update Date | 03/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1307 WHITE HORSE RD BUILDING B
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-2176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-772-9444
-----------------------------------------------------
Fax | 856-772-2325
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1307 WHITE HORSE RD BUILDING B
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-2176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-772-9444
-----------------------------------------------------
Fax | 856-772-2325
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | DS018710L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 22D100923600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------