Provider Demographics
NPI:1821455502
Name:JERSEY DENTAL GROUP
Entity Type:Organization
Organization Name:JERSEY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIR
Authorized Official - Middle Name:RASHID
Authorized Official - Last Name:ALIKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-835-4043
Mailing Address - Street 1:1900 MOUNT HOLLY RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4722
Mailing Address - Country:US
Mailing Address - Phone:609-835-4043
Mailing Address - Fax:609-835-1576
Practice Address - Street 1:1900 MOUNT HOLLY RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4722
Practice Address - Country:US
Practice Address - Phone:609-835-4043
Practice Address - Fax:609-835-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01354000122300000X
NJ22DI02624000122300000X
NJ22DI02383100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty