Provider Demographics
NPI:1902212020
Name:SOMERS POINT DENTAL, PC
Entity Type:Organization
Organization Name:SOMERS POINT DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-879-6456
Mailing Address - Street 1:425 ROUTE 9 S
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-2225
Mailing Address - Country:US
Mailing Address - Phone:609-879-6456
Mailing Address - Fax:609-879-6486
Practice Address - Street 1:425 ROUTE 9 S
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-2225
Practice Address - Country:US
Practice Address - Phone:609-879-6456
Practice Address - Fax:609-879-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 020487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty