Provider Demographics
NPI:1073723888
Name:IRENA JUG-WEISS,D.M.D.,L.L.C.
Entity Type:Organization
Organization Name:IRENA JUG-WEISS,D.M.D.,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUG-WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-779-7450
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2621
Mailing Address - Country:US
Mailing Address - Phone:856-779-7450
Mailing Address - Fax:856-779-7702
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2621
Practice Address - Country:US
Practice Address - Phone:856-779-7450
Practice Address - Fax:856-779-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0162911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDI0162910OtherSTATE DENTAL LICENSE