Provider Demographics
NPI:1790749695
Name:BLITZ, MEREDITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:BLITZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:BLITZ-GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:28 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1479
Mailing Address - Country:US
Mailing Address - Phone:973-831-0382
Mailing Address - Fax:973-831-6942
Practice Address - Street 1:28 JACKSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1479
Practice Address - Country:US
Practice Address - Phone:973-831-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 197181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8505306Medicaid
NJU96362Medicare UPIN
NJ8505306Medicaid