=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588626196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTISTRY FOR SPECIAL PEOPLE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1910 MARLTON PIKE E STE 9
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08003-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-424-5955
-----------------------------------------------------
Fax | 856-424-8382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1910 MARLTON PIKE E STE 9
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08003-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-424-5955
-----------------------------------------------------
Fax | 856-424-8382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. JOANN BICKING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-424-5955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 1859201
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------