Provider Demographics
NPI:1316574825
Name:SOUTH JERSEY DENTAL CARE
Entity Type:Organization
Organization Name:SOUTH JERSEY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (SELF)
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FICOI
Authorized Official - Phone:267-250-8082
Mailing Address - Street 1:212 W ROUTE 38
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057
Mailing Address - Country:US
Mailing Address - Phone:856-206-9559
Mailing Address - Fax:856-206-9399
Practice Address - Street 1:212 W ROUTE 38
Practice Address - Street 2:SUITE 500
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-206-9559
Practice Address - Fax:856-206-9399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH JERSEY DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty