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General NPI Number Information
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NPI Number | 1801307046
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Entity Type | Organization
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Legal Business Name | DM PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 2800 ROUTE 130 N SUITE 108
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City | CINNAMINSON
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State | NJ
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Zip | 08077
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Country | US
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Telephone | 856-786-1881
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Fax | 856-786-5233
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Provider Business Mailing Address
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Address Line | 1000 LINCOLN DRIVE EAST SUITE 3A
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City | MARLTON
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State | NJ
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Zip | 08053
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Country | US
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Telephone | 856-786-1881
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Fax | 856-786-5233
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Authorized Official
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Title or Position | OWNER
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Name | SPENCER SAINT-CYR
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Credential | DMD
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Telephone | 856-786-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22D102677800
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License Number State | NJ
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