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General NPI Number Information
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NPI Number | 1972655017
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Entity Type | Individual
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Provider Name | JERRY J POPECK DMD PC
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 133 NORTH BROADWAY SUITE B
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City | PENNSVILLE
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State | NJ
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Zip | 08070
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Country | US
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Telephone | 856-678-6393
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Fax | 856-678-6816
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Provider Business Mailing Address
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Address Line | 133 NORTH BROADWAY SUITE B
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City | PENNSVILLE
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State | NJ
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Zip | 08070
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Country | US
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Telephone | 856-678-6393
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Fax | 856-678-6816
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DI019021
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License Number State | NJ
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