| My Dentist | |
|
16 W Vine St Millville NJ 08332-3823 | |
| (856) 825-0618 | |
| (856) 825-3420 |
| Full Name | My Dentist |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 16 W Vine St, Millville, New Jersey |
| Authorized Official Name and Position | George Georgi Kourakin (OWNER) |
| Authorized Official Contact | 8568250618 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| My Dentist 16 W Vine St Millville NJ 08332-3823 Ph: (856) 825-0618 | My Dentist 16 W Vine St Millville NJ 08332-3823 Ph: (856) 825-0618 |
| NPI Number | 1760530943 |
|---|---|
| Provider Enumeration Date | 01/06/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760530943 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D13065 (New Jersey) | Primary |
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