Provider Demographics
NPI:1053748004
Name:PLEASANTVILLE DENTAL, LLC
Entity type:Organization
Organization Name:PLEASANTVILLE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-266-6724
Mailing Address - Street 1:9 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3028
Practice Address - Country:US
Practice Address - Phone:856-206-9255
Practice Address - Fax:856-206-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty