Provider Demographics
NPI:1497904437
Name:JACKSON JOINT VENTURES LIMITED LIABILITY
Entity Type:Organization
Organization Name:JACKSON JOINT VENTURES LIMITED LIABILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCLAFANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-901-1970
Mailing Address - Street 1:1102 BENNETTS MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527
Mailing Address - Country:US
Mailing Address - Phone:732-901-1970
Mailing Address - Fax:732-901-3844
Practice Address - Street 1:1102 BENNETTS MILLS ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527
Practice Address - Country:US
Practice Address - Phone:732-901-1970
Practice Address - Fax:732-901-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0146211223G0001X
NJ10191381223G0001X
NJ10211081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty