MEDICARE: TAP DENTISTRY LLC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1184638579	OTHER	NJ	NPI

General Provider Information

NPI Number	:	1700058930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAP DENTISTRY LLC

Provider Business Mailing Address
First Line	:	2001 LIBERTY PL
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-5707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 LIBERTY PL
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-5707
Country	:	US
Telephone Number	:	856-875-9595
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	KENYA CHAMBERS
Credential	:
Telephone Number	:	856-875-9595

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/27/2008

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