Provider Demographics
NPI:1265014591
Name:DAGV PA
Entity Type:Organization
Organization Name:DAGV PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDELEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-334-0082
Mailing Address - Street 1:1233 HADDONFIELD BERLIN RD STE 6
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4378
Mailing Address - Country:US
Mailing Address - Phone:856-768-8988
Mailing Address - Fax:856-768-2518
Practice Address - Street 1:1233 HADDONFIELD BERLIN RD STE 6
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4378
Practice Address - Country:US
Practice Address - Phone:856-768-8988
Practice Address - Fax:856-768-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty