Provider Demographics
NPI:1275711145
Name:DYER, DOTTIE DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOTTIE
Middle Name:DEAN
Last Name:DYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DOTTIE
Other - Middle Name:DEAN
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:860 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2018
Mailing Address - Country:US
Mailing Address - Phone:609-561-9150
Mailing Address - Fax:609-561-9383
Practice Address - Street 1:238 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1108
Practice Address - Country:US
Practice Address - Phone:856-935-7711
Practice Address - Fax:856-935-9123
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1022600001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0155667Medicaid
NJ510593461OtherMETLIFE