Provider Demographics
NPI:1790909307
Name:ADVANCED DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ADVANCED DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:B SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-601-9300
Mailing Address - Street 1:98 ROUTE 9
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-601-9300
Mailing Address - Fax:609-601-2878
Practice Address - Street 1:98 ROUTE 9
Practice Address - Street 2:SUITE 4
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-601-9300
Practice Address - Fax:609-601-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty