Provider Demographics
NPI:1457843500
Name:COMMUNITY DENTAL OF SALEM, P.C.
Entity Type:Organization
Organization Name:COMMUNITY DENTAL OF SALEM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-273-5119
Mailing Address - Street 1:709 SOUTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070
Mailing Address - Country:US
Mailing Address - Phone:917-273-5119
Mailing Address - Fax:
Practice Address - Street 1:709 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070
Practice Address - Country:US
Practice Address - Phone:917-273-5119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty