MEDICARE: DA VINCI DENTAL, P.C.

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	1223G0001X	General Practice Dentistry	22DI02057400	NJ

General Provider Information

NPI Number	:	1689892945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DA VINCI DENTAL, P.C.

Provider Business Mailing Address
First Line	:	216 HADDON AVE
Second Line	:	SUITE 104
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-2809
Country	:	US
Telephone Number	:	856-869-0300
Fax Number	:	856-869-0500

Provider Business Practice Location Address
First Line	:	216 HADDON AVE
Second Line	:	SUITE 104
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-2809
Country	:	US
Telephone Number	:	856-869-0300
Fax Number	:	856-869-0500

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOANN STETTLER
Credential	:	D.M.D.
Telephone Number	:	856-869-0300

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/14/2008

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