Provider Demographics
NPI:1861834749
Name:PREMIUM DENTAL SPECIALTIES, PC
Entity Type:Organization
Organization Name:PREMIUM DENTAL SPECIALTIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:APPELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-235-4696
Mailing Address - Street 1:1221 N CHURCH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1245
Mailing Address - Country:US
Mailing Address - Phone:856-235-0020
Mailing Address - Fax:856-235-0017
Practice Address - Street 1:176 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2000
Practice Address - Country:US
Practice Address - Phone:856-235-4696
Practice Address - Fax:856-235-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021438001223E0200X
NJ22DI020358001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty