Provider Demographics
NPI:1962422501
Name:MARVIN, JEFFREY T (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:MARVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S NEW PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1734
Mailing Address - Country:US
Mailing Address - Phone:732-364-1700
Mailing Address - Fax:
Practice Address - Street 1:155 S NEW PROSPECT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1734
Practice Address - Country:US
Practice Address - Phone:732-364-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ116901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice