MEDICARE: PENNS GROVE FAMILY DENTAL 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1760800346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNS GROVE FAMILY DENTAL LLC

Provider Business Mailing Address
First Line	:	31 W MAIN ST
Second Line	:
City	:	PENNS GROVE
State	:	NJ
Zip	:	08069-1348
Country	:	US
Telephone Number	:	856-299-1096
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 W MAIN ST
Second Line	:
City	:	PENNS GROVE
State	:	NJ
Zip	:	08069-1348
Country	:	US
Telephone Number	:	856-299-1096
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. SYLVAN GARFUNKEL
Credential	:
Telephone Number	:	856-299-1096

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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Directions to “PENNS GROVE FAMILY DENTAL LLC ” Practice Location

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