Provider Demographics
NPI:1760726723
Name:DENTAL ASSOCIATES OF JERSEY CITY LLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF JERSEY CITY LLC
Other - Org Name:NANCY HANNA DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-433-0773
Mailing Address - Street 1:2766 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5508
Mailing Address - Country:US
Mailing Address - Phone:201-433-0773
Mailing Address - Fax:
Practice Address - Street 1:2766 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5508
Practice Address - Country:US
Practice Address - Phone:201-433-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18874122300000X
NJ09956122300000X
NJ107175001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6412700Medicaid