Provider Demographics
NPI:1497891188
Name:MAINLAND DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:MAINLAND DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-641-1065
Mailing Address - Street 1:50 W BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2645
Mailing Address - Country:US
Mailing Address - Phone:609-641-1065
Mailing Address - Fax:609-645-0162
Practice Address - Street 1:50 W BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2645
Practice Address - Country:US
Practice Address - Phone:609-641-1065
Practice Address - Fax:609-645-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI011241001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty