Provider Demographics
NPI:1134142417
Name:DENTAL GROUP OF MILLVILLE, LLC
Entity Type:Organization
Organization Name:DENTAL GROUP OF MILLVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-825-9000
Mailing Address - Street 1:1018 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2527
Mailing Address - Country:US
Mailing Address - Phone:856-825-9000
Mailing Address - Fax:856-327-0767
Practice Address - Street 1:1018 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2527
Practice Address - Country:US
Practice Address - Phone:856-825-9000
Practice Address - Fax:856-327-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ189031223G0001X
NJ190111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1315046OtherUNITED CONCORDIA
NJ335724OtherUNITED CONCORDIA
NJ60008837OtherHORIZON NJ HEALTH
NJ60008334OtherHORIZON NJ HEALTH