Provider Demographics
NPI:1609878602
Name:QUALITY DENTAL CARE
Entity Type:Organization
Organization Name:QUALITY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-691-0290
Mailing Address - Street 1:301 S MAIN RD
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7897
Mailing Address - Country:US
Mailing Address - Phone:856-691-0290
Mailing Address - Fax:856-691-6425
Practice Address - Street 1:301 S MAIN RD
Practice Address - Street 2:SUITE B-4
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7897
Practice Address - Country:US
Practice Address - Phone:856-691-0290
Practice Address - Fax:856-691-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI018645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1223D0001XOtherDENTAL PUBLIC HEALTH