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General NPI Number Information
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NPI Number | 1538618756
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALISTS OF VOORHEES
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 1307 WHITE HORSE RD SUITE 502
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City | VOORHEES
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State | NJ
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Zip | 08043-2176
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Country | US
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Telephone | 856-888-1365
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 WHITE HORSE RD SUITE 502
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City | VOORHEES
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State | NJ
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Zip | 08043-2176
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Country | US
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Telephone | 856-888-1365
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | DR. ROBERT DESIPIO JR.
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Credential | DMD
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Telephone | 856-627-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI01749100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI01821002
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License Number State | NJ
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