Provider Demographics
NPI:1306049259
Name:WYCKOFF-NESTER, LLP
Entity type:Organization
Organization Name:WYCKOFF-NESTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WYCKOFF
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-468-5858
Mailing Address - Street 1:200 E MANTUA AVE
Mailing Address - Street 2:PO BOX 37
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1921
Mailing Address - Country:US
Mailing Address - Phone:856-468-5858
Mailing Address - Fax:856-468-9098
Practice Address - Street 1:200 E MANTUA AVE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1921
Practice Address - Country:US
Practice Address - Phone:856-468-5858
Practice Address - Fax:856-468-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ117281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1255365235OtherINDIVIDUAL
NJ1225096712OtherINDIVIDUAL