Provider Demographics
NPI:1760755102
Name:VIP DENTAL, PA
Entity Type:Organization
Organization Name:VIP DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-500-3815
Mailing Address - Street 1:9002 LINCOLN DR W
Mailing Address - Street 2:SUITE H
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3204
Mailing Address - Country:US
Mailing Address - Phone:609-500-3815
Mailing Address - Fax:856-983-9877
Practice Address - Street 1:9002 LINCOLN DR W
Practice Address - Street 2:SUITE H
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3204
Practice Address - Country:US
Practice Address - Phone:609-500-3815
Practice Address - Fax:856-983-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017451001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty