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General NPI Number Information
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NPI Number | 1184139669
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Entity Type | Organization
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Legal Business Name | VINELAND DENTOFACIAL ASSOCIATES
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 435 W LANDIS AVE
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City | VINELAND
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State | NJ
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Zip | 08360-8105
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Country | US
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Telephone | 856-691-3220
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Fax | 856-507-9732
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Provider Business Mailing Address
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Address Line | 435 W LANDIS AVE
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City | VINELAND
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State | NJ
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Zip | 08360-8105
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Country | US
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Telephone | 856-691-3220
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Fax | 856-507-9732
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT HENRY CARLSON
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Credential | DDS
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Telephone | 856-507-9732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22D102696200
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License Number State | NJ
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