Provider Demographics
NPI:1285722785
Name:PODOLNICK, DAVID (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PODOLNICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:HERSHEL
Other - Middle Name:DAVID
Other - Last Name:PODOLNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3932 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3107
Mailing Address - Country:US
Mailing Address - Phone:609-909-1100
Mailing Address - Fax:609-909-9199
Practice Address - Street 1:3932 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3107
Practice Address - Country:US
Practice Address - Phone:609-909-1100
Practice Address - Fax:609-909-9199
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018120001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA807715OtherUNITED CONCORDIA PROVIDER
NJ0177OtherDELTA DENTAL PROVIDER ID