Provider Demographics
NPI:1144212234
Name:PLAWNER, JACOB M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:M
Last Name:PLAWNER
Suffix:
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 1:51 HAMILTON DR E
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4627
Mailing Address - Country:US
Mailing Address - Phone:973-420-1474
Mailing Address - Fax:
Practice Address - Street 1:700 N BROAD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2310
Practice Address - Country:US
Practice Address - Phone:908-354-8678
Practice Address - Fax:908-354-5864
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ136131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3326004Medicaid