Provider Demographics
NPI:1568713592
Name:ORTHODONTICS @ FORKED RIVER
Entity Type:Organization
Organization Name:ORTHODONTICS @ FORKED RIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-693-0117
Mailing Address - Street 1:620 WEST LACEY ROAD, SUITE 6
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-2244
Mailing Address - Country:US
Mailing Address - Phone:609-693-0117
Mailing Address - Fax:609-693-7555
Practice Address - Street 1:620 WEST LACEY ROAD. SUITE 6
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2244
Practice Address - Country:US
Practice Address - Phone:609-693-0117
Practice Address - Fax:609-693-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI008125001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty