Provider Demographics
NPI:1790367431
Name:COBBLESTONE KIDS PEDIATRIC DENTISTRY OF NEW JERSEY
Entity type:Organization
Organization Name:COBBLESTONE KIDS PEDIATRIC DENTISTRY OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIDOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, MHRM
Authorized Official - Phone:267-909-9551
Mailing Address - Street 1:1352 SOUTH ST STE C4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1858
Mailing Address - Country:US
Mailing Address - Phone:267-909-9551
Mailing Address - Fax:267-909-9761
Practice Address - Street 1:17 W ORMOND AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3041
Practice Address - Country:US
Practice Address - Phone:856-288-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty