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General NPI Number Information
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NPI Number | 1942419098
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Entity Type | Organization
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Legal Business Name | BORDENTOWN DENTAL ARTS, LLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3 THIRD STREET SUITE 101
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City | BORDENTOWN
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State | NJ
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Zip | 08505-1321
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Country | US
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Telephone | 609-298-1964
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Fax | 609-298-8443
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Provider Business Mailing Address
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Address Line | 3 THIRD STREET SUITE 101
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City | BORDENTOWN
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State | NJ
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Zip | 08505-1321
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Country | US
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Telephone | 609-298-1964
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Fax | 609-298-8443
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK BIRNBAUM
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Credential | DMD
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Telephone | 609-298-1964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DIO18752
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License Number State | NJ
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