Provider Demographics
NPI:1508396458
Name:VAN PELT, ERICA (DDS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:VAN PELT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3339
Mailing Address - Country:US
Mailing Address - Phone:856-889-3147
Mailing Address - Fax:
Practice Address - Street 1:200 E MANTUA AVE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1921
Practice Address - Country:US
Practice Address - Phone:856-468-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0426071223G0001X
NJ22DI027043001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice