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General NPI Number Information
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NPI Number | 1528975539
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Entity Type | Individual
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Provider Name | IRENE JOHN
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Gender | Female
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 1320 FAIRVIEW BLVD STE B
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City | DELRAN
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State | NJ
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Zip | 08075-2036
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Country | US
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Telephone | 856-764-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 9972 GARDENIA LN
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City | PHILADELPHIA
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State | PA
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Zip | 19115-1100
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Country | US
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Telephone | 267-973-1878
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI03171100
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License Number State | NJ
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