Provider Demographics
NPI:1972877298
Name:COMPREHENSIVE FAMILY DENTISTRY
Entity type:Organization
Organization Name:COMPREHENSIVE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HONRYCHS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-753-2900
Mailing Address - Street 1:180 ROUTE 73 NORTH
Mailing Address - Street 2:SUITE 1202 STURBRIDGE OFFICE PARK
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9505
Mailing Address - Country:US
Mailing Address - Phone:856-753-2900
Mailing Address - Fax:856-753-5151
Practice Address - Street 1:180 ROUTE 73
Practice Address - Street 2:SUITE 1202 STURBRIDGE OFFICE PARK
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9546
Practice Address - Country:US
Practice Address - Phone:856-753-2900
Practice Address - Fax:856-753-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1570300122300000X
NJ2408500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6877401Medicaid
NJ0248673Medicaid
NJ7407602Medicaid