Provider Demographics
NPI:1487412169
Name:CROWN'D DENTISTRY
Entity type:Organization
Organization Name:CROWN'D DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICICCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-352-5255
Mailing Address - Street 1:188 FRIES MILL RD STE D3
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2060
Mailing Address - Country:US
Mailing Address - Phone:856-352-5255
Mailing Address - Fax:856-352-5253
Practice Address - Street 1:188 FRIES MILL RD STE D3
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2060
Practice Address - Country:US
Practice Address - Phone:856-352-5255
Practice Address - Fax:856-352-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental