Provider Demographics
NPI:1003965690
Name:TARNOFSKY, SUSAN B (DDS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:TARNOFSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3800
Mailing Address - Country:US
Mailing Address - Phone:973-669-1599
Mailing Address - Fax:
Practice Address - Street 1:35 FADEM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3115
Practice Address - Country:US
Practice Address - Phone:973-379-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1184300Medicaid