Provider Demographics
NPI:1770629776
Name:MUFSON, SAMUEL P (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:P
Last Name:MUFSON
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 1:595 CHESTNUT RIDGE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677
Mailing Address - Country:US
Mailing Address - Phone:201-784-3372
Mailing Address - Fax:
Practice Address - Street 1:595 CHESTNUT RIDGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-7663
Practice Address - Country:US
Practice Address - Phone:201-391-4466
Practice Address - Fax:201-391-0422
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist