Provider Demographics
NPI:1386991735
Name:JAISWAL, BEVERLY (DMD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:JAISWAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 GROVE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-2139
Mailing Address - Country:US
Mailing Address - Phone:856-345-9490
Mailing Address - Fax:856-579-7863
Practice Address - Street 1:196 GROVE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086-2139
Practice Address - Country:US
Practice Address - Phone:856-345-9490
Practice Address - Fax:856-579-7863
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043431122300000X
NJ22DI02504700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist