Provider Demographics
NPI:1982976882
Name:GIBBSTOWN DENTISTRY, INC.
Entity Type:Organization
Organization Name:GIBBSTOWN DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:KRATCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-599-1350
Mailing Address - Street 1:401 HARMONY RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:GIBBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08027-1723
Mailing Address - Country:US
Mailing Address - Phone:856-599-1350
Mailing Address - Fax:856-599-1351
Practice Address - Street 1:401 HARMONY RD
Practice Address - Street 2:SUITE 14
Practice Address - City:GIBBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08027-1723
Practice Address - Country:US
Practice Address - Phone:856-599-1350
Practice Address - Fax:856-599-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024085001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty