Provider Demographics
NPI:1275750135
Name:PERIODONTAL ASSOCIATES OF SOUTHERN NEW JERSEY, P.C.
Entity Type:Organization
Organization Name:PERIODONTAL ASSOCIATES OF SOUTHERN NEW JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-589-9233
Mailing Address - Street 1:100B KINGS WAY W
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2235
Mailing Address - Country:US
Mailing Address - Phone:856-589-9233
Mailing Address - Fax:856-582-2439
Practice Address - Street 1:100B KINGS WAY W
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2235
Practice Address - Country:US
Practice Address - Phone:856-589-9233
Practice Address - Fax:856-582-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty