Provider Demographics
NPI:1518403393
Name:ALPHA DENTAL SPA LLC
Entity Type:Organization
Organization Name:ALPHA DENTAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-829-1989
Mailing Address - Street 1:2103 BRANCH PIKE STE 16
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3044
Mailing Address - Country:US
Mailing Address - Phone:856-829-1989
Mailing Address - Fax:856-829-5014
Practice Address - Street 1:2103 BRANCH PIKE STE 16
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3044
Practice Address - Country:US
Practice Address - Phone:856-829-1989
Practice Address - Fax:856-829-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01956704261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental