Provider Demographics
NPI:1740063940
Name:GIBBSBORO LV DENTAL, LLC
Entity type:Organization
Organization Name:GIBBSBORO LV DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-302-7026
Mailing Address - Street 1:63 N LAKEVIEW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1026
Mailing Address - Country:US
Mailing Address - Phone:856-784-7900
Mailing Address - Fax:856-784-5904
Practice Address - Street 1:63 N LAKEVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1026
Practice Address - Country:US
Practice Address - Phone:856-784-7900
Practice Address - Fax:856-784-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty