Provider Demographics
NPI:1801307046
Name:DM PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:DM PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT-CYR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-786-1881
Mailing Address - Street 1:1000 LINCOLN DRIVE EAST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-786-1881
Mailing Address - Fax:856-786-5233
Practice Address - Street 1:2800 ROUTE 130 N
Practice Address - Street 2:SUITE 108
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077
Practice Address - Country:US
Practice Address - Phone:856-786-1881
Practice Address - Fax:856-786-5233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DM PEDIATRIC DENTISTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1026778001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty