Provider Demographics
NPI:1609932748
Name:CHARLES P PROCINI DDS PA
Entity Type:Organization
Organization Name:CHARLES P PROCINI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENET
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:PROCINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-983-8888
Mailing Address - Street 1:9001 LINCOLN DR W STE B
Mailing Address - Street 2:ROUTE 73
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3202
Mailing Address - Country:US
Mailing Address - Phone:856-983-8888
Mailing Address - Fax:856-983-2461
Practice Address - Street 1:9001 LINCOLN DR W STE B
Practice Address - Street 2:ROUTE 73
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3202
Practice Address - Country:US
Practice Address - Phone:856-983-8888
Practice Address - Fax:856-983-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ110481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty