Provider Demographics
NPI:1790189975
Name:SOUTH JERSEY FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:SOUTH JERSEY FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BAQIR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-563-9860
Mailing Address - Street 1:366 LINCOLN AVE N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2343
Mailing Address - Country:US
Mailing Address - Phone:973-563-9860
Mailing Address - Fax:
Practice Address - Street 1:366 LINCOLN AVE N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2343
Practice Address - Country:US
Practice Address - Phone:973-563-9860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02315200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty