Provider Demographics
NPI:1407336902
Name:COMPASS DENTAL AT MARLTON CROSSING
Entity Type:Organization
Organization Name:COMPASS DENTAL AT MARLTON CROSSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERELMUT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-596-3737
Mailing Address - Street 1:564 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4810
Mailing Address - Country:US
Mailing Address - Phone:856-596-3737
Mailing Address - Fax:
Practice Address - Street 1:564 LIPPINCOTT DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4810
Practice Address - Country:US
Practice Address - Phone:856-596-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1093236259OtherPERSONAL NPI