Provider Demographics
NPI:1235576182
Name:ATLAS DENTAL SPECIALTY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ATLAS DENTAL SPECIALTY ASSOCIATES LLC
Other - Org Name:HADDONFIELD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:856-857-0400
Mailing Address - Street 1:63 KRESSON RD
Mailing Address - Street 2:SUITE 102
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:
Practice Address - Street 1:63 KRESSON RD
Practice Address - Street 2:SUITE 102
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:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025344001223P0300X
NJ22DI024042001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty