Provider Demographics
NPI:1790853687
Name:JEFFERSON DENTAL HEALTH P.C.
Entity Type:Organization
Organization Name:JEFFERSON DENTAL HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRMAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:AUJLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-788-7070
Mailing Address - Street 1:1304 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4500
Mailing Address - Country:US
Mailing Address - Phone:315-788-7070
Mailing Address - Fax:315-788-6927
Practice Address - Street 1:1304 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4500
Practice Address - Country:US
Practice Address - Phone:315-788-7070
Practice Address - Fax:315-788-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0497951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02255301Medicaid