Provider Demographics
NPI:1053194266
Name:CHERRY HILL LV DENTAL, LLC
Entity type:Organization
Organization Name:CHERRY HILL LV DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-302-7026
Mailing Address - Street 1:101 MARLTON PIKE E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2403
Mailing Address - Country:US
Mailing Address - Phone:856-424-3335
Mailing Address - Fax:856-424-8753
Practice Address - Street 1:101 MARLTON PIKE E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2403
Practice Address - Country:US
Practice Address - Phone:856-424-3335
Practice Address - Fax:856-424-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty