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General NPI Number Information
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NPI Number | 1760608012
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Entity Type | Organization
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Legal Business Name | ORTHO ONE
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 HADDONFIELD BERLIN RD SUITE 26
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City | VOORHEES
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State | NJ
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Zip | 08043
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Country | US
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Telephone | 856-566-1240
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Fax | 856-566-1250
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Provider Business Mailing Address
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Address Line | 12 QUAIL RIDGE CT
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City | MEDFORD
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State | NJ
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Zip | 08055
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Country | US
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Telephone | 609-714-8946
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Fax | 609-714-8946
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVID J CARRUTHERS
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Credential |
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Telephone | 856-566-1240
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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 | DI02153500
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License Number State | NJ
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