Provider Demographics
NPI:1053447466
Name:ELBAUM, JACK C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:C
Last Name:ELBAUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:203 ELM ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3120
Mailing Address - Country:US
Mailing Address - Phone:908-232-4400
Mailing Address - Fax:908-232-0575
Practice Address - Street 1:203 ELM ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3120
Practice Address - Country:US
Practice Address - Phone:908-232-4400
Practice Address - Fax:908-232-0575
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ149261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice