Provider Demographics
NPI:1588229488
Name:WILLINGBORO DENTAL ASSOCIATES,LLC
Entity Type:Organization
Organization Name:WILLINGBORO DENTAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-816-5408
Mailing Address - Street 1:2A ROSE ST
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2538
Mailing Address - Country:US
Mailing Address - Phone:609-877-7687
Mailing Address - Fax:
Practice Address - Street 1:2A ROSE ST
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2538
Practice Address - Country:US
Practice Address - Phone:609-877-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty