Provider Demographics
NPI:1043424815
Name:IRWIN, SYLVIA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:L
Last Name:IRWIN
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 1:51 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2003
Mailing Address - Country:US
Mailing Address - Phone:973-667-1567
Mailing Address - Fax:973-667-9107
Practice Address - Street 1:242 WASHINGTON AVE
Practice Address - Street 2:SUTIE D
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3934
Practice Address - Country:US
Practice Address - Phone:973-667-1567
Practice Address - Fax:973-667-9107
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist