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General NPI Number Information
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NPI Number | 1386857159
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Entity Type | Individual
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Provider Name | RICHARD S BIRNBAUM DMD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1423 TILTON RD STE 2
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1857
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Country | US
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Telephone | 609-646-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 16 OBYRNE DR
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City | SOMERS POINT
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State | NJ
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Zip | 08244-2514
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Country | US
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Telephone | 609-927-4414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22D101189201
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License Number State | NJ
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