Provider Demographics
NPI:1942503651
Name:MERCERVILLE FAMILY DENTAL
Entity Type:Organization
Organization Name:MERCERVILLE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUTFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-890-0810
Mailing Address - Street 1:2211 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-2600
Mailing Address - Country:US
Mailing Address - Phone:609-890-0810
Mailing Address - Fax:609-890-0620
Practice Address - Street 1:2211 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:STE 2
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-2600
Practice Address - Country:US
Practice Address - Phone:609-890-0810
Practice Address - Fax:609-890-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty