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General NPI Number Information
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NPI Number | 1982743944
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Entity Type | Organization
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Legal Business Name | BARRY E ETTELSON DDS PA
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 ROUTE 168 STE I6 WASHINGTON PROFESSIONAL CAMPUS
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-3212
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Country | US
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Telephone | 856-227-2554
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Fax | 856-227-4066
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Provider Business Mailing Address
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Address Line | 900 ROUTE 168 STE I6 WASHINGTON PROFESSIONAL CAMPUS
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-3212
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Country | US
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Telephone | 856-227-2554
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Fax | 856-227-4066
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | DR. BARRY E ETTELSON
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Credential | DDS
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Telephone | 856-227-2554
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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 | D5015997L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08424
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License Number State | NJ
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