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General NPI Number Information
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NPI Number | 1164540290
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Entity Type | Organization
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Legal Business Name | HADDONFIELD DENTAL, LLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 63 KRESSON RD STE 102
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3200
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Country | US
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Telephone | 856-857-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 63 KRESSON RD STE 102
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3200
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Country | US
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Telephone | 856-857-0400
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Fax | 856-216-0779
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Authorized Official
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Title or Position | TREASURER
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Name | MRS. JOHANNA P REED
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Credential | MBA
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Telephone | 856-857-0400
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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 | DI019404
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DI019194
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License Number State | NJ
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