Provider Demographics
NPI:1194118174
Name:JUNGWIRTH, MICHAEL (DMD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:JUNGWIRTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BERGEN ST
Mailing Address - Street 2:ROOM B854
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2495
Mailing Address - Country:US
Mailing Address - Phone:973-972-3126
Mailing Address - Fax:973-972-7322
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:ROOM B854
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-3126
Practice Address - Fax:973-972-7322
Is Sole Proprietor?:No
Enumeration Date:2015-03-14
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DR02922122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program