Provider Demographics
NPI:1245697788
Name:JASON NUDELMAN, DDS PC
Entity type:Organization
Organization Name:JASON NUDELMAN, DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:B
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-291-6888
Mailing Address - Street 1:975 TUCKERTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2663
Mailing Address - Country:US
Mailing Address - Phone:856-291-6888
Mailing Address - Fax:856-985-3412
Practice Address - Street 1:17 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:732-238-5100
Practice Address - Fax:732-238-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022987001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty