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General NPI Number Information
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NPI Number | 1972532158
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES OF SOUTH JERSEY, PA
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 KINGS HWY S 4B
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2500
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Country | US
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Telephone | 856-429-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 401 KINGS HWY S 4B
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2500
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Country | US
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Telephone | 856-429-2225
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Fax |
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Authorized Official
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Title or Position | PARTNER/DENTIST
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Name | DR. ROBERT P GERSH
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Credential | D.M.D.
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Telephone | 856-429-2225
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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 | NJ21760
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | NJ8986
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License Number State | NJ
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