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General NPI Number Information
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NPI Number | 1174697973
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY PROSTHODONTIC ASSOC. PA
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 1793 SPRINGDALE RD
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2136
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Country | US
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Telephone | 856-424-7177
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Fax | 856-424-0896
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Provider Business Mailing Address
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Address Line | 1793 SPRINGDALE RD
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2136
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Country | US
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Telephone | 856-424-7177
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Fax | 856-424-0896
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN R COHEN
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Credential | DDS
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Telephone | 856-424-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State | NJ
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