Provider Demographics
NPI:1235670811
Name:WOODBURY DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:WOODBURY DENTAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-6630
Mailing Address - Street 1:1050 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1141
Mailing Address - Country:US
Mailing Address - Phone:856-848-6630
Mailing Address - Fax:856-848-7294
Practice Address - Street 1:1050 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1141
Practice Address - Country:US
Practice Address - Phone:856-848-6630
Practice Address - Fax:856-848-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02559400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty