Provider Demographics
NPI:1306179056
Name:DENTAL CARE OF HAMMONTON, LLC
Entity Type:Organization
Organization Name:DENTAL CARE OF HAMMONTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-567-4888
Mailing Address - Street 1:858 S WHITE HORSE PIKE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2031
Mailing Address - Country:US
Mailing Address - Phone:609-567-4888
Mailing Address - Fax:609-567-4751
Practice Address - Street 1:858 S WHITE HORSE PIKE
Practice Address - Street 2:SUITE B1
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2031
Practice Address - Country:US
Practice Address - Phone:609-567-4888
Practice Address - Fax:609-567-4751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty