Provider Demographics
NPI:1679659692
Name:CHUSTCKIE, JEFFREY H (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:CHUSTCKIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CEDAR GROVE LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6462
Mailing Address - Country:US
Mailing Address - Phone:732-271-1220
Mailing Address - Fax:
Practice Address - Street 1:120 CEDAR GROVE LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-6462
Practice Address - Country:US
Practice Address - Phone:732-271-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ150571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice