Provider Demographics
NPI:1093937583
Name:DENTAL CARE OF VINELAND, P.A.
Entity Type:Organization
Organization Name:DENTAL CARE OF VINELAND, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-691-2553
Mailing Address - Street 1:1500 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-6610
Mailing Address - Country:US
Mailing Address - Phone:856-691-2553
Mailing Address - Fax:856-691-3370
Practice Address - Street 1:1500 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-6610
Practice Address - Country:US
Practice Address - Phone:856-691-2553
Practice Address - Fax:856-691-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ182481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty