Provider Demographics
NPI:1891721346
Name:BORDENTOWN FAMILY DENTAL PC
Entity Type:Organization
Organization Name:BORDENTOWN FAMILY DENTAL PC
Other - Org Name:URKEN & STONEBACK PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-298-0259
Mailing Address - Street 1:227 FARNSWORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1807
Mailing Address - Country:US
Mailing Address - Phone:609-298-0059
Mailing Address - Fax:609-291-8588
Practice Address - Street 1:227 FARNSWORTH AVENUE
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1807
Practice Address - Country:US
Practice Address - Phone:609-298-0059
Practice Address - Fax:609-291-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD115050122300000X
NJD12109L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty