Provider Demographics
NPI:1366337842
Name:COMMUNITY DENTAL OF PEMBERTON, P.C.
Entity type:Organization
Organization Name:COMMUNITY DENTAL OF PEMBERTON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-751-8117
Mailing Address - Street 1:109 GALESTOWN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08515
Mailing Address - Country:US
Mailing Address - Phone:215-962-5668
Mailing Address - Fax:
Practice Address - Street 1:18 BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015
Practice Address - Country:US
Practice Address - Phone:609-997-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty