Provider Demographics
NPI:1639249055
Name:PINELANDS FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:PINELANDS FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-953-9999
Mailing Address - Street 1:332 STOKES ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8477
Mailing Address - Country:US
Mailing Address - Phone:609-953-9999
Mailing Address - Fax:609-953-9940
Practice Address - Street 1:332 STOKES ROAD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8477
Practice Address - Country:US
Practice Address - Phone:609-953-9999
Practice Address - Fax:609-953-9940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017100001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty