Provider Demographics
NPI:1568476208
Name:MOUNT LAUREL DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:MOUNT LAUREL DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-778-0022
Mailing Address - Street 1:220 UNION MILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9532
Mailing Address - Country:US
Mailing Address - Phone:856-778-0022
Mailing Address - Fax:
Practice Address - Street 1:220 UNION MILL RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9532
Practice Address - Country:US
Practice Address - Phone:856-778-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ117661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty