Provider Demographics
NPI:1124294632
Name:MOORESTOWN DENTAL PROFESSIONALS, P.C.
Entity type:Organization
Organization Name:MOORESTOWN DENTAL PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSH-ESMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-234-4474
Mailing Address - Street 1:517 PLEASANT VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3209
Mailing Address - Country:US
Mailing Address - Phone:856-234-4474
Mailing Address - Fax:
Practice Address - Street 1:517 PLEASANT VALLEY AVE
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3209
Practice Address - Country:US
Practice Address - Phone:856-234-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI020236400122300000X
NJDI02023100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty