Provider Demographics
NPI:1578043741
Name:ADVANCED DENTAL OF HOLMDEL
Entity Type:Organization
Organization Name:ADVANCED DENTAL OF HOLMDEL
Other - Org Name:ADVANCED DENTAL OF HOLMDEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PICKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-851-8500
Mailing Address - Street 1:721 N BEERS ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1500
Mailing Address - Country:US
Mailing Address - Phone:732-851-8500
Mailing Address - Fax:
Practice Address - Street 1:721 N BEERS ST STE 2A
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-851-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies