Provider Demographics
NPI:1386845154
Name:NORTHFIELD FAMILY DENTAL GROUP
Entity type:Organization
Organization Name:NORTHFIELD FAMILY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAGGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-646-9100
Mailing Address - Street 1:1423 TILTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225
Mailing Address - Country:US
Mailing Address - Phone:609-646-9100
Mailing Address - Fax:609-646-3016
Practice Address - Street 1:1423 TILTON RD
Practice Address - Street 2:STE 2
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225
Practice Address - Country:US
Practice Address - Phone:609-646-9100
Practice Address - Fax:609-646-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01139300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty