Provider Demographics
NPI:1689443210
Name:PREMIERE DENTAL OF WEST DEPTFORD
Entity type:Organization
Organization Name:PREMIERE DENTAL OF WEST DEPTFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-463-0565
Mailing Address - Street 1:800 JESSUP RD STE 805
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-9354
Mailing Address - Country:US
Mailing Address - Phone:856-845-3299
Mailing Address - Fax:856-845-5342
Practice Address - Street 1:800 JESSUP RD STE 805
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086-9354
Practice Address - Country:US
Practice Address - Phone:856-845-3299
Practice Address - Fax:856-845-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty