Full Name | Llc |
---|---|
Speciality | Dentist |
Location | 1021 Marlton Pike West, Cherry Hill, New Jersey |
Authorized Official Name and Position | Mitchell Brudno (OWNER SOLE MEMBER LLC) |
Authorized Official Contact | 8564294249 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Llc 1021 Marlton Pike West Cherry Hill NJ 08002 Ph: (856) 429-4249 | Llc 1021 Marlton Pike West Cherry Hill NJ 08002 Ph: (856) 429-4249 |
NPI Number | 1154443026 |
---|---|
Provider Enumeration Date | 04/04/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154443026 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | NJDI15818 (New Jersey) | Primary |
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