| LLC | |
|
1021 Marlton Pike West Cherry Hill NJ 08002 | |
| (856) 429-4249 | |
| Not Available |
| 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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