Provider Demographics
NPI:1861208175
Name:SOUTH PHILADELPHIA ORTHODONTIC ASSOCIATES DBA CENTERTON ORTHODONTICS
Entity type:Organization
Organization Name:SOUTH PHILADELPHIA ORTHODONTIC ASSOCIATES DBA CENTERTON ORTHODONTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:856-358-6800
Mailing Address - Street 1:681 CENTERTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-3946
Mailing Address - Country:US
Mailing Address - Phone:856-358-6800
Mailing Address - Fax:
Practice Address - Street 1:681 CENTERTON RD
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318-3946
Practice Address - Country:US
Practice Address - Phone:856-358-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH PHILADELPHIA ORTHODONTIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1548280654OtherNPPES
PA1427503051OtherNPPES