Provider Demographics
NPI:1275648081
Name:JEFFREY R MACK DMD PA
Entity Type:Organization
Organization Name:JEFFREY R MACK DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-728-3519
Mailing Address - Street 1:1085 N BLACK HORSE PIKE
Mailing Address - Street 2:STE 3
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094
Mailing Address - Country:US
Mailing Address - Phone:856-728-3519
Mailing Address - Fax:
Practice Address - Street 1:1085 N BLACK HORSE PIKE
Practice Address - Street 2:STE 3
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094
Practice Address - Country:US
Practice Address - Phone:856-728-3519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty