| NPI | 1861519456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEWIS PROFFITT Director 856-983-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 11364) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 09460) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 07879) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 23068) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |