Provider Demographics
NPI:1073616686
Name:GIRALT, ENRIQUE JR (DDS)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:GIRALT
Suffix:JR
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 1:13 PONDEROSA TRAIL
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871
Mailing Address - Country:US
Mailing Address - Phone:973-383-6083
Mailing Address - Fax:973-663-6166
Practice Address - Street 1:706 RT 15 SOUTH
Practice Address - Street 2:STE 101
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849
Practice Address - Country:US
Practice Address - Phone:973-663-0990
Practice Address - Fax:973-663-6166
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI18006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist