Provider Demographics
NPI:1083827430
Name:DENTOFACIAL ASSOCIATES,PA
Entity Type:Organization
Organization Name:DENTOFACIAL ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-691-3220
Mailing Address - Street 1:435 W. LANDIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-691-3220
Mailing Address - Fax:856-507-9731
Practice Address - Street 1:435 W. LANDIS AVENUE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-691-3220
Practice Address - Fax:856-507-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty