NPIMap

Organization Active NPI

Deptford Family Dental PA

  • Dentist
  • Deptford, NJ
National Provider Identifier
1528207198
Registry record updated Feb 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI017432 Issued in NJ
Legal business name
DEPTFORD FAMILY DENTAL PA
Practice address
2000 Clements Bridge Rd
Suite 117 a
Deptford, NJ 08096-2011
Phone
(856) 848-6006
Fax
(856) 848-6969
NPI assigned
Feb 5, 2009
Last updated
Feb 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Edward Poller, DDSNPI 1780660803
Title
President
Phone
(732) 914-1039

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22DI017432 NJ Primary

Addresses

Primary practice location

2000 Clements Bridge Rd
Suite 117 a
Deptford, NJ 08096-2011

Mailing address

2000 Clements Bridge Rd
Suite 117 a
Deptford, NJ 08096-2011
Phone (856) 848-6006

National Provider Directory

National Provider Directory

Locations

2000 Clements Bridge Rd
Ste 117A
Deptford, NJ 08096
Phone (856) 848-6006

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233792000000",
    "number": "1528207198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 CLEMENTS BRIDGE RD",
            "address_2": "SUITE 117 A",
            "city": "DEPTFORD",
            "state": "NJ",
            "postal_code": "080962011",
            "telephone_number": "856-848-6006",
            "fax_number": "856-848-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 CLEMENTS BRIDGE RD",
            "address_2": "SUITE 117 A",
            "city": "DEPTFORD",
            "state": "NJ",
            "postal_code": "080962011",
            "telephone_number": "856-848-6006",
            "fax_number": "856-848-6969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPTFORD FAMILY DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-05",
        "last_updated": "2009-02-05",
        "status": "A",
        "authorized_official_last_name": "POLLER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-914-1039",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI017432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deptford, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.