Kool Koala Pediatric And Adolescent Dentistry
Dentist, Pediatric Dentistry in Collingswood, NJ. Organization (NPI-2).
NPI number1295112043
StatusActive
Last updated in NPPESApr 30, 2015
Details
- NPI
- 1295112043
- Entity type
- Organization (NPI-2)
- Legal business name
- Kool Koala Pediatric And Adolescent Dentistry
- Organization subpart
- No
- Enumeration date
- Apr 30, 2015
- Last updated
- Apr 30, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | 22DIO2447503 | NJ | Yes |
Practice location
501 Whitehorse PikeCollingswood, NJ 08107
Phone 856-230-0924
Mailing address
501 Whitehorse PikeCollingswood, NJ 08107
Phone 856-230-0924
Authorized official
Frederick Vernon Ballard
Ceo
8562300924
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