Provider Demographics
NPI:1891849394
Name:PHUCAS, CARLYN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLYN
Middle Name:S
Last Name:PHUCAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:MARLTON GREENE PLAZA
Mailing Address - Street 2:36 W ROUTE 70 SUITE 212
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3024
Mailing Address - Country:US
Mailing Address - Phone:856-985-9400
Mailing Address - Fax:856-985-3412
Practice Address - Street 1:36 W ROUTE 70 MARLTON GREENE PLAZA
Practice Address - Street 2:SUITE 212
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3024
Practice Address - Country:US
Practice Address - Phone:856-985-9400
Practice Address - Fax:856-985-3412
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI155401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics