1972877298 NPI number — COMPREHENSIVE FAMILY DENTISTRY

Table of content: MS. SHARON RAE HELWIG OPTICIAN (NPI 1073692216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972877298 NPI number — COMPREHENSIVE FAMILY DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE FAMILY DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972877298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 ROUTE 73 NORTH
Provider Second Line Business Mailing Address:
SUITE 1202 STURBRIDGE OFFICE PARK
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-9505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-753-2900
Provider Business Mailing Address Fax Number:
856-753-5151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 ROUTE 73
Provider Second Line Business Practice Location Address:
SUITE 1202 STURBRIDGE OFFICE PARK
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-9546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-753-2900
Provider Business Practice Location Address Fax Number:
856-753-5151
Provider Enumeration Date:
03/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HONRYCHS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
BENJAMIN
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
856-753-2900

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2408500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 1570300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6877401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0248673 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7407602 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".