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General NPI Number Information
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NPI Number | 1609878602
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Entity Type | Organization
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Legal Business Name | QUALITY DENTAL CARE
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 S MAIN RD SUITE B-4
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City | VINELAND
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State | NJ
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Zip | 08360-7897
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Country | US
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Telephone | 856-691-0290
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Fax | 856-691-6425
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Provider Business Mailing Address
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Address Line | 301 S MAIN RD SUITE B-4
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City | VINELAND
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State | NJ
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Zip | 08360-7897
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Country | US
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Telephone | 856-691-0290
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Fax | 856-691-6425
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL A. KISSELL
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Credential | D.D.S.
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Telephone | 856-691-0290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DI018645
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License Number State | NJ
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