Provider Demographics
NPI:1639437502
Name:HADDON FAMILY DENTISTRY
Entity type:Organization
Organization Name:HADDON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DWORAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-854-1010
Mailing Address - Street 1:1197 MARIKRESS RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-854-1010
Mailing Address - Fax:856-854-1016
Practice Address - Street 1:1197 MARIKRESS RD
Practice Address - Street 2:BUILDING B
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-854-1010
Practice Address - Fax:856-854-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DJ023083001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty