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General NPI Number Information
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NPI Number | 1942718465
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL OF SICKLERVILLE, P.C.
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 513 CROSS KEYS ROAD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081
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Country | US
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Telephone | 856-818-9710
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Fax |
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Provider Business Mailing Address
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Address Line | 513 CROSS KEYS ROAD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081
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Country | US
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Telephone | 856-818-9710
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TODD PRAGER
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Credential | D.D.S.
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Telephone | 917-273-5119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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