Provider Demographics
NPI:1174663785
Name:TADROS, JACKLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:
Last Name:TADROS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2018
Mailing Address - Country:US
Mailing Address - Phone:609-567-0200
Mailing Address - Fax:609-704-1482
Practice Address - Street 1:600 PEMBERTON-BROWNS MILLS ROAD
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:NJ
Practice Address - Zip Code:08064
Practice Address - Country:US
Practice Address - Phone:609-894-1213
Practice Address - Fax:609-894-1219
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02324300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist