MEDICARE: MFCD HADDONFIELD 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1982187456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MFCD HADDONFIELD LLC

Provider Business Mailing Address
First Line	:	151 GREENTREE RD STE A
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-9416
Country	:	US
Telephone Number	:	856-983-9620
Fax Number	:	856-983-7714

Provider Business Practice Location Address
First Line	:	300 N HADDON AVE
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-1723
Country	:	US
Telephone Number	:	856-429-0404
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. NICHOLA RICH
Credential	:
Telephone Number	:	856-983-9620

Provider Enumeration Date	:	09/11/2018
Last Update Date	:	09/11/2018

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