Provider Demographics
NPI:1164540290
Name:HADDONFIELD DENTAL, LLC
Entity Type:Organization
Organization Name:HADDONFIELD DENTAL, LLC
Other - Org Name:JOSEPH R. REED, DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:856-857-0400
Mailing Address - Street 1:63 KRESSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3200
Mailing Address - Country:US
Mailing Address - Phone:856-857-0400
Mailing Address - Fax:856-216-0779
Practice Address - Street 1:63 KRESSON RD STE 102
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3200
Practice Address - Country:US
Practice Address - Phone:856-857-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI019194122300000X
NJDI019404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDI019194OtherSTATE LICENSE NUMBER
NJDI019404OtherSTATE LICENSE NUMBER