Provider Demographics
NPI:1972532158
Name:PEDIATRIC DENTAL ASSOCIATES OF SOUTH JERSEY, PA
Entity type:Organization
Organization Name:PEDIATRIC DENTAL ASSOCIATES OF SOUTH JERSEY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:GERSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-429-2225
Mailing Address - Street 1:401 KINGS HWY S
Mailing Address - Street 2:4B
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2500
Mailing Address - Country:US
Mailing Address - Phone:856-429-2225
Mailing Address - Fax:
Practice Address - Street 1:401 KINGS HWY S
Practice Address - Street 2:4B
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2500
Practice Address - Country:US
Practice Address - Phone:856-429-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ89861223P0221X
NJNJ217601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty