Provider Demographics
NPI:1346450913
Name:JEFFERSON FAMILY DENTISTRY
Entity type:Organization
Organization Name:JEFFERSON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRALT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:973-663-0990
Mailing Address - Street 1:706 RT. 15 SOUTH
Mailing Address - Street 2:STE.101
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849
Mailing Address - Country:US
Mailing Address - Phone:973-663-0990
Mailing Address - Fax:973-663-6166
Practice Address - Street 1:706 ROUTE 15 SOUTH
Practice Address - Street 2:STE.101
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849
Practice Address - Country:US
Practice Address - Phone:973-663-0990
Practice Address - Fax:973-663-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI18006261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental