Provider Demographics
NPI:1457680225
Name:FAMILY DENTAL CARE OF SOUTH JERSEY
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-309-2244
Mailing Address - Street 1:707 HADDONFIELD BERLIN RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3714
Mailing Address - Country:US
Mailing Address - Phone:856-309-2244
Mailing Address - Fax:856-309-2247
Practice Address - Street 1:707 HADDONFIELD BERLIN ROAD
Practice Address - Street 2:UNIT B
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-309-2244
Practice Address - Fax:856-309-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017054001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty