Provider Demographics
NPI:1174634653
Name:REISMAN, STEVEN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:REISMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAUREL OAK RD STE C1
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3506
Mailing Address - Country:US
Mailing Address - Phone:856-783-5777
Mailing Address - Fax:856-783-1095
Practice Address - Street 1:1001 LAUREL OAK RD STE C1
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3506
Practice Address - Country:US
Practice Address - Phone:856-783-5777
Practice Address - Fax:856-783-1095
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11841OtherDENTIST