Holdbrook Pediatric Dental, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

22DI02298200 Issued in NJ

Legal business name

HOLDBROOK PEDIATRIC DENTAL, LLC

Practice address

553 Beckett Rd
Suite 604
Swedesboro, NJ 08085-1565

Phone

(856) 556-4020

Fax

(856) 241-1251

NPI assigned

Jan 17, 2013

Last updated

Jan 17, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Wendell Holdbrook, DMDNPI 1134109069

Title

Owner

Phone

(856) 783-0444

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 3

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.

• Wendell Holdbrook, D.M.D

  • Pediatric Dentistry
  • Gibbsboro, NJ
  • NPI 1134109069
  Medicare reassignment NPD Authorized official
• Melissa Kathleen Blake, D.M.D

  • Pediatric Dentistry
  • Burlington, NC
  • NPI 1801275946
  NPD (past)
• Debra Pisarcik, D.M.D.

  • Pediatric Dentistry
  • West Grove, PA
  • NPI 1134328115
  NPD (past)

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

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1679811129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 HADDONFIELD BERLIN RD",
            "address_2": "SUITE 101",
            "city": "GIBBSBORO",
            "state": "NJ",
            "postal_code": "080261228",
            "telephone_number": "856-783-0444",
            "fax_number": "856-241-1251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 BECKETT RD",
            "address_2": "SUITE 604",
            "city": "SWEDESBORO",
            "state": "NJ",
            "postal_code": "080851565",
            "telephone_number": "856-556-4020",
            "fax_number": "856-241-1251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLDBROOK PEDIATRIC DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-17",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "HOLDBROOK",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-783-0444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02445300",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02298200",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02463800",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02379500",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0212768",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily V Hatton, BSN, RN
• Jaclyn A Heineman, OTR/L
• Hess Ankle and Foot Center, LLC
• Leslie Alan Hess, DPM
• Andre H Hoffman, M.D.
• Honest Wellness and Weight Loss LLC
• Julia Rose Honigfeld
• Juanita Kimberly Huggins, D.O.
• Katherine Hurlock, BCBS
• Lucia Ingraldi, COTA

• Pediatric Dentistry in Swedesboro, NJ
• Providers in Swedesboro, NJ by specialty
• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.