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General NPI Number Information
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NPI Number | 1477356574
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Entity Type | Organization
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Legal Business Name | UPPER DEERFIELD DENTISTRY PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 233 LAUREL HEIGHTS DR
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City | BRIDGETON
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State | NJ
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Zip | 08302-3635
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Country | US
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Telephone | 856-455-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 233 LAUREL HEIGHTS DR
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City | BRIDGETON
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State | NJ
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Zip | 08302-3635
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Country | US
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Telephone | 856-455-7111
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Fax |
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Authorized Official
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Title or Position | BILLING AND CREDENTIALING MANAGER
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Name | SUSAN DUNFORD
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Credential |
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Telephone | 313-342-1997
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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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