Provider Demographics
NPI:1346457397
Name:AUDUBON ORAL HEALTH CENTER
Entity Type:Organization
Organization Name:AUDUBON ORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOJDANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-546-1942
Mailing Address - Street 1:100 BLACKHORSE PIKE
Mailing Address - Street 2:SUITE D-4
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106
Mailing Address - Country:US
Mailing Address - Phone:856-546-1942
Mailing Address - Fax:856-546-7305
Practice Address - Street 1:100 BLACKHORSE PIKE
Practice Address - Street 2:SUITE D-4
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106
Practice Address - Country:US
Practice Address - Phone:856-546-1942
Practice Address - Fax:856-546-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020078001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty