Provider Demographics
NPI:1013562438
Name:PITMAN DENTAL INC
Entity Type:Organization
Organization Name:PITMAN DENTAL INC
Other - Org Name:PITMAN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:267-357-7119
Mailing Address - Street 1:1960 CARDINAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2904
Mailing Address - Country:US
Mailing Address - Phone:267-357-7119
Mailing Address - Fax:
Practice Address - Street 1:107 W JERSEY AVE
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-1129
Practice Address - Country:US
Practice Address - Phone:856-589-3592
Practice Address - Fax:856-589-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty