Provider Demographics
NPI:1609948041
Name:JEFFREY A. KIMELMAN, DMD, PC
Entity Type:Organization
Organization Name:JEFFREY A. KIMELMAN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIMELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-227-8888
Mailing Address - Street 1:123 EGG HARBOR ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-227-8888
Mailing Address - Fax:856-227-8001
Practice Address - Street 1:123 EGG HARBOR ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-227-8888
Practice Address - Fax:856-227-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ161541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty