Provider Demographics
NPI:1124736947
Name:DENTAL CARE OF MULLICA HILL LLC
Entity type:Organization
Organization Name:DENTAL CARE OF MULLICA HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTISANI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-691-2553
Mailing Address - Street 1:1500 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-6610
Mailing Address - Country:US
Mailing Address - Phone:856-691-2553
Mailing Address - Fax:856-691-3370
Practice Address - Street 1:108 SWEDESBORO RD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1800
Practice Address - Country:US
Practice Address - Phone:856-691-2553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental