Provider Demographics
NPI:1013452929
Name:DENTAL CHOICE, PC
Entity Type:Organization
Organization Name:DENTAL CHOICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELBA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:BONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-983-9300
Mailing Address - Street 1:875 RTE 73 NORTH
Mailing Address - Street 2:SUITE H
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-983-9300
Mailing Address - Fax:856-983-9003
Practice Address - Street 1:875 RTE 73 NORTH
Practice Address - Street 2:SUITE H
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-983-9300
Practice Address - Fax:856-983-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-31
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01927200122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8427101Medicaid