Provider Demographics
NPI:1235525486
Name:ENCORE DENTAL OF JACKSON
Entity Type:Organization
Organization Name:ENCORE DENTAL OF JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-202-7008
Mailing Address - Street 1:2275 WEST COUNTY LINE RD.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527
Mailing Address - Country:US
Mailing Address - Phone:732-534-9555
Mailing Address - Fax:732-534-9559
Practice Address - Street 1:2275 WEST COUNTY LINE RD.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527
Practice Address - Country:US
Practice Address - Phone:732-534-9555
Practice Address - Fax:732-534-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty