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General NPI Number Information
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NPI Number | 1295582005
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Entity Type | Organization
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Legal Business Name | LITTLE SMILES PEDIATRIC DENTISTRY OF SOUTH JERSEY
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Dates
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Enumeration Date | 05/01/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 1206 W SHERMAN AVE STE 4D
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City | VINELAND
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State | NJ
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Zip | 08360-6911
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Country | US
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Telephone | 856-368-2800
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Fax | 856-412-5100
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Provider Business Mailing Address
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Address Line | 1206 W SHERMAN AVE STE 4D
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City | VINELAND
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State | NJ
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Zip | 08360-6911
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Country | US
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Telephone | 856-368-2800
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Fax | 856-412-5100
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Authorized Official
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Title or Position | CREDENTIALING/AR
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Name | DARLENE L MANDER
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Credential |
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Telephone | 856-207-8406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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