Provider Demographics
NPI:1447319744
Name:KEITH L. DUNOFF, DMD, PA
Entity type:Organization
Organization Name:KEITH L. DUNOFF, DMD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:DUNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-753-1547
Mailing Address - Street 1:339 N ROUTE 73
Mailing Address - Street 2:SUITE 4 WINSLOW PROFESSIONAL BUILDING
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9707
Mailing Address - Country:US
Mailing Address - Phone:856-753-1547
Mailing Address - Fax:856-753-1548
Practice Address - Street 1:339 N ROUTE 73
Practice Address - Street 2:SUITE 4 WINSLOW PROFESSIONAL BUILDING
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9707
Practice Address - Country:US
Practice Address - Phone:856-753-1547
Practice Address - Fax:856-753-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI14766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty