Provider Demographics
NPI:1245308444
Name:SOUTH JERSEY PERIODONTICS PC
Entity type:Organization
Organization Name:SOUTH JERSEY PERIODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZACHS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-646-8443
Mailing Address - Street 1:3069 ENGLISH CREEK AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9708
Mailing Address - Country:US
Mailing Address - Phone:609-646-8443
Mailing Address - Fax:609-646-2758
Practice Address - Street 1:3069 ENGLISH CREEK AVE
Practice Address - Street 2:STE 101
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9708
Practice Address - Country:US
Practice Address - Phone:609-646-8443
Practice Address - Fax:609-646-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty