Provider Demographics
NPI:1730305640
Name:WASHINGTON TWP DENTAL ASSOC, P.A.
Entity Type:Organization
Organization Name:WASHINGTON TWP DENTAL ASSOC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-582-1000
Mailing Address - Street 1:474 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:ATRIUM ONE SUITE A
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2321
Mailing Address - Country:US
Mailing Address - Phone:856-582-1000
Mailing Address - Fax:856-589-1093
Practice Address - Street 1:474 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:ATRIUM ONE SUITE A
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2321
Practice Address - Country:US
Practice Address - Phone:856-582-1000
Practice Address - Fax:856-589-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI23083122300000X
NJDI19807122300000X
NJDI11620122300000X
NJDI08926122300000X
NJDI07861122300000X
NJDI14249122300000X
NJDI022151223P0221X
NJDI012162001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1073643797OtherDENTIST
NJ1912037326OtherDENTIST
NJ1508995473OtherDENTIST
NJ1154450047OtherDENTIST
NJ1982733945OtherDENTIST
NJ1194874958OtherPERIODONTIST
NJ1801925649OtherDENTIST
NJ1871622787OtherPEDIATRIC SPECIALIST