Provider Demographics
NPI:1124735550
Name:COMMUNITY DENTAL OF LAWNSIDE
Entity type:Organization
Organization Name:COMMUNITY DENTAL OF LAWNSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-267-4200
Mailing Address - Street 1:1817 MT. HOLLY ROAD
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016
Mailing Address - Country:US
Mailing Address - Phone:609-267-4200
Mailing Address - Fax:
Practice Address - Street 1:130 NORTH WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:LAWNSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08045
Practice Address - Country:US
Practice Address - Phone:856-229-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty