MEDICARE: ACORN DENTAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI00903200	NJ
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22DI01122502	NJ
3	1223P0300X	Periodontics	22DI01834400	NJ

General Provider Information

NPI Number	:	1306964226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACORN DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	100 CENTRE BLVD
Second Line	:	SUITE J
City	:	MARLTON
State	:	NJ
Zip	:	08053-4128
Country	:	US
Telephone Number	:	856-983-0060
Fax Number	:	856-983-3356

Provider Business Practice Location Address
First Line	:	100 CENTRE BLVD
Second Line	:	SUITE J
City	:	MARLTON
State	:	NJ
Zip	:	08053-4128
Country	:	US
Telephone Number	:	856-983-0060
Fax Number	:	856-983-3356

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDERICK R VAN ISTENDAL JR.
Credential	:	DDS
Telephone Number	:	856-983-0060

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	09/11/2025

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