Provider Demographics
NPI:1508481565
Name:KIDS FIRST PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-638-1234
Mailing Address - Street 1:740 MARNE HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3126
Mailing Address - Country:US
Mailing Address - Phone:856-638-1234
Mailing Address - Fax:
Practice Address - Street 1:740 MARNE HWY STE 103
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3126
Practice Address - Country:US
Practice Address - Phone:856-638-1234
Practice Address - Fax:856-638-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty