Provider Demographics
NPI:1104599745
Name:CLEMENTON FAMILY DENTISTRY P C
Entity type:Organization
Organization Name:CLEMENTON FAMILY DENTISTRY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-783-4949
Mailing Address - Street 1:132 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4159
Mailing Address - Country:US
Mailing Address - Phone:856-783-4949
Mailing Address - Fax:856-783-9766
Practice Address - Street 1:132 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4159
Practice Address - Country:US
Practice Address - Phone:856-783-4949
Practice Address - Fax:856-783-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty