Provider Demographics
NPI:1750783585
Name:ACORN DENTAL SLEEP MEDICINE CENTERS LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:ACORN DENTAL SLEEP MEDICINE CENTERS LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAN ISTENDAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-983-0060
Mailing Address - Street 1:100 CENTRE BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4128
Mailing Address - Country:US
Mailing Address - Phone:856-983-0060
Mailing Address - Fax:856-983-3356
Practice Address - Street 1:100 CENTRE BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4128
Practice Address - Country:US
Practice Address - Phone:856-983-0060
Practice Address - Fax:856-983-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00903200261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental