Provider Demographics
NPI:1275709636
Name:SR CUSPAL HOLDINGS, LLC
Entity Type:Organization
Organization Name:SR CUSPAL HOLDINGS, LLC
Other - Org Name:NEW ALBANY FAMILY DENTISTRY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZONIES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-905-2690
Mailing Address - Street 1:2800 ROUTE 130 N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3035
Mailing Address - Country:US
Mailing Address - Phone:856-786-1881
Mailing Address - Fax:
Practice Address - Street 1:2800 ROUTE 130 N
Practice Address - Street 2:SUITE 108
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3035
Practice Address - Country:US
Practice Address - Phone:856-786-1881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty