Provider Demographics
NPI:1306964226
Name:ACORN DENTAL ASSOCIATES
Entity type:Organization
Organization Name:ACORN DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAN ISTENDAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-983-0060
Mailing Address - Street 1:100 CENTRE BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4128
Mailing Address - Country:US
Mailing Address - Phone:856-983-0060
Mailing Address - Fax:856-983-3356
Practice Address - Street 1:100 CENTRE BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4128
Practice Address - Country:US
Practice Address - Phone:856-983-0060
Practice Address - Fax:856-983-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00903200122300000X
NJ22DI018344001223P0300X
NJ22DI011225021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty