Provider Demographics
NPI:1790821262
Name:UNGAR, JONATHAN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:UNGAR
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 1:110 HILLSIDE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3394
Mailing Address - Country:US
Mailing Address - Phone:732-333-3383
Mailing Address - Fax:815-301-9612
Practice Address - Street 1:110 HILLSIDE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3394
Practice Address - Country:US
Practice Address - Phone:732-333-3383
Practice Address - Fax:815-301-9612
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022638001223G0001X
NY051567-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice