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General NPI Number Information
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NPI Number | 1366337842
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL OF PEMBERTON, P.C.
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 18 BROADWAY STREET
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City | BROWNS MILLS
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State | NJ
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Zip | 08015
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Country | US
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Telephone | 609-997-2929
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Fax |
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Provider Business Mailing Address
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Address Line | 109 GALESTOWN CIRCLE
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City | CHESTERFIELD
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State | NJ
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Zip | 08515
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Country | US
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Telephone | 215-962-5668
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLENN PRAGER
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Credential | DDS
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Telephone | 917-751-8117
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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 |
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License Number State |
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