Provider Demographics
NPI:1821873035
Name:HAJJAR, ANTHONY (DDS, CAGS, MDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:HAJJAR
Suffix:
Gender:M
Credentials:DDS, CAGS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 KRUEGER CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3464
Mailing Address - Country:US
Mailing Address - Phone:646-684-9344
Mailing Address - Fax:
Practice Address - Street 1:1050 CAMINO RICARDO
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4305
Practice Address - Country:US
Practice Address - Phone:646-684-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist