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General NPI Number Information
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NPI Number | 1700919594
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Entity Type | Organization
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Legal Business Name | WOODBINE DENTAL PA
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 901 DEHIRSCH AVENUE
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City | WOODBINE
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State | NJ
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Zip | 08270
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Country | US
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Telephone | 609-861-2784
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Fax | 609-861-3160
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Provider Business Mailing Address
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Address Line | 901 DEHIRSCH AVENUE
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City | WOODBINE
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State | NJ
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Zip | 08270
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Country | US
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Telephone | 609-861-2784
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Fax | 609-861-3160
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | JACQUES NATHAN
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Credential | DDS
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Telephone | 609-861-2784
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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 | 22DI00879400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI01862600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI01877400
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License Number State | NJ
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