Provider Demographics
NPI:1588868871
Name:JUG-WEISS, IRENA (DMD)
Entity type:Individual
Prefix:DR
First Name:IRENA
Middle Name:
Last Name:JUG-WEISS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:IRENA
Other - Middle Name:
Other - Last Name:JUG-WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2621
Mailing Address - Country:US
Mailing Address - Phone:856-779-7450
Mailing Address - Fax:
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2621
Practice Address - Country:US
Practice Address - Phone:856-779-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI01629101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDI0162910OtherDENTAL LICENSE #