Provider Demographics
NPI:1689892945
Name:DA VINCI DENTAL, P.C.
Entity Type:Organization
Organization Name:DA VINCI DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:STETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-869-0300
Mailing Address - Street 1:216 HADDON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2809
Mailing Address - Country:US
Mailing Address - Phone:856-869-0300
Mailing Address - Fax:856-869-0500
Practice Address - Street 1:216 HADDON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2809
Practice Address - Country:US
Practice Address - Phone:856-869-0300
Practice Address - Fax:856-869-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020574001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty