Provider Demographics
NPI:1407974686
Name:WITHANACHCHI, JONICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONICE
Middle Name:
Last Name:WITHANACHCHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JONICE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:93 STATE ROUTE 183
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-2694
Mailing Address - Country:US
Mailing Address - Phone:973-448-8989
Mailing Address - Fax:
Practice Address - Street 1:93 STATE ROUTE 183
Practice Address - Street 2:
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874-2694
Practice Address - Country:US
Practice Address - Phone:973-448-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000088122300000X
NJ22DI00231231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist