Provider Demographics
NPI:1992189179
Name:PEDIATRIC DENTISTRY OF MULLICA HILL, LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF MULLICA HILL, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-238-2853
Mailing Address - Street 1:4 BURTON LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9422
Mailing Address - Country:US
Mailing Address - Phone:856-842-5400
Mailing Address - Fax:856-842-5220
Practice Address - Street 1:4 BURTON LN
Practice Address - Street 2:SUITE 400
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9422
Practice Address - Country:US
Practice Address - Phone:856-842-5400
Practice Address - Fax:856-842-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023441001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty