Provider Demographics
NPI:1831815547
Name:JERSEY HEIGHTS DENTAL CARE, LLC
Entity type:Organization
Organization Name:JERSEY HEIGHTS DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEBORJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-200-0286
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8912
Mailing Address - Country:US
Mailing Address - Phone:410-200-0286
Mailing Address - Fax:410-822-0577
Practice Address - Street 1:3524 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3448
Practice Address - Country:US
Practice Address - Phone:201-484-7474
Practice Address - Fax:210-473-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental