Provider Demographics
NPI:1982723748
Name:MONROE PEDIATRIC DENTAL CENTER
Entity Type:Organization
Organization Name:MONROE PEDIATRIC DENTAL CENTER
Other - Org Name:MONROE PEDIATRIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:SOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-409-0499
Mailing Address - Street 1:18 CENTRE DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831
Mailing Address - Country:US
Mailing Address - Phone:609-409-0499
Mailing Address - Fax:609-409-7499
Practice Address - Street 1:18 CENTRE DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831
Practice Address - Country:US
Practice Address - Phone:609-409-0499
Practice Address - Fax:609-409-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021406001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty