Provider Demographics
NPI:1255478343
Name:STAFFORDSHIRE DENTAL GROUP PA
Entity Type:Organization
Organization Name:STAFFORDSHIRE DENTAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:LENAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-627-3400
Mailing Address - Street 1:1307 WHITE HORSE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2176
Mailing Address - Country:US
Mailing Address - Phone:856-627-3400
Mailing Address - Fax:856-627-3628
Practice Address - Street 1:1307 WHITE HORSE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2176
Practice Address - Country:US
Practice Address - Phone:856-627-3400
Practice Address - Fax:856-627-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI130831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty