Provider Demographics
NPI:1942419098
Name:BORDENTOWN DENTAL ARTS, LLC
Entity Type:Organization
Organization Name:BORDENTOWN DENTAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRNBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-298-1964
Mailing Address - Street 1:3 THIRD STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1321
Mailing Address - Country:US
Mailing Address - Phone:609-298-1964
Mailing Address - Fax:609-298-8443
Practice Address - Street 1:3 THIRD STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1321
Practice Address - Country:US
Practice Address - Phone:609-298-1964
Practice Address - Fax:609-298-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO18752261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental