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General NPI Number Information
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NPI Number | 1346061173
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Entity Type | Organization
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Legal Business Name | DUCK DUCK TOOTH PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1560B N OLDEN AVE
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City | EWING
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State | NJ
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Zip | 08638-3204
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Country | US
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Telephone | 609-538-3825
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Fax |
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Provider Business Mailing Address
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Address Line | 124 N CENTRE ST
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAYA THOMPSON
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Credential |
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Telephone | 609-538-3825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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