Provider Demographics
NPI:1275699316
Name:PROCINI, CHARLES P (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:PROCINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9001 LINCOLN DR W STE B
Mailing Address - Street 2:ROUTE 73
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3202
Mailing Address - Country:US
Mailing Address - Phone:856-983-8888
Mailing Address - Fax:856-983-2461
Practice Address - Street 1:9001 LINCOLN DR W STE B
Practice Address - Street 2:ROUTE 73
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3202
Practice Address - Country:US
Practice Address - Phone:856-983-8888
Practice Address - Fax:856-983-2461
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ110481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics