Provider Demographics
NPI:1033300272
Name:EDENBAUM, DAVID R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:EDENBAUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 A LIPPINCOTT DRIVE
Mailing Address - Street 2:BLDG B
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08035
Mailing Address - Country:US
Mailing Address - Phone:856-985-1800
Mailing Address - Fax:856-985-7170
Practice Address - Street 1:560 A LIPPINCOTT DRIVE
Practice Address - Street 2:BLDG B
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08035
Practice Address - Country:US
Practice Address - Phone:856-985-1800
Practice Address - Fax:856-985-7170
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 174911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics