Provider Demographics
NPI:1639296643
Name:SS DENTAL
Entity Type:Organization
Organization Name:SS DENTAL
Other - Org Name:JERSEY CITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SCHACHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-434-0919
Mailing Address - Street 1:162 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2814
Mailing Address - Country:US
Mailing Address - Phone:201-434-0919
Mailing Address - Fax:201-434-1453
Practice Address - Street 1:162 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2814
Practice Address - Country:US
Practice Address - Phone:201-434-0919
Practice Address - Fax:201-434-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI198341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty