Provider Demographics
NPI:1689884561
Name:BOOKMAN, MIRYAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIRYAM
Middle Name:
Last Name:BOOKMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N COUNTY LINE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4421
Mailing Address - Country:US
Mailing Address - Phone:732-942-0909
Mailing Address - Fax:932-942-0929
Practice Address - Street 1:180 N COUNTY LINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4421
Practice Address - Country:US
Practice Address - Phone:732-942-0909
Practice Address - Fax:732-942-0929
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02209100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist