Provider Demographics
NPI:1346518362
Name:POPECK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:POPECK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:POPECK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-678-6393
Mailing Address - Street 1:133 N BROADWAY
Mailing Address - Street 2:B
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1649
Mailing Address - Country:US
Mailing Address - Phone:856-678-6393
Mailing Address - Fax:856-678-6816
Practice Address - Street 1:133 N BROADWAY
Practice Address - Street 2:B
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1649
Practice Address - Country:US
Practice Address - Phone:856-678-6393
Practice Address - Fax:856-678-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0190211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty