Provider Demographics
NPI:1275600447
Name:CENTER FOR PERIODONTAL HEALTH
Entity Type:Organization
Organization Name:CENTER FOR PERIODONTAL HEALTH
Other - Org Name:CENTER FOR ORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-462-8181
Mailing Address - Street 1:507 STILLWELLS CORNER ROAD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-462-8181
Mailing Address - Fax:732-462-0023
Practice Address - Street 1:507 STILLWELLS CORNER ROAD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-462-8181
Practice Address - Fax:732-462-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009657001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty