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General NPI Number Information
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NPI Number | 1710134671
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Entity Type | Individual
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Provider Name | JENNIFER MCCORMACK DMD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 319 W LANDIS AVE
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City | VINELAND
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State | NJ
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Zip | 08360-8101
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Country | US
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Telephone | 856-691-3300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 597 53 S LAUREL ST, 2ND FLOOR
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City | BRIDGETON
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State | NJ
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Zip | 08302-0433
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Country | US
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Telephone | 856-451-4700
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02381100
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License Number State | NJ
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