Provider Demographics
NPI:1083775977
Name:THE DAYSPRING CENTER FOR LASER DENTISTRY
Entity Type:Organization
Organization Name:THE DAYSPRING CENTER FOR LASER DENTISTRY
Other - Org Name:DAYSPRING DENTAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:F
Authorized Official - Last Name:BICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-875-8400
Mailing Address - Street 1:188 FRIES MILL ROAD
Mailing Address - Street 2:SUITE E2
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-875-8400
Mailing Address - Fax:856-875-5329
Practice Address - Street 1:188 FRIES MILL ROAD
Practice Address - Street 2:SUITE E2
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-875-8400
Practice Address - Fax:856-875-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI18611122300000X
NJDI18737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty