Provider Demographics
NPI:1861851768
Name:SANJURJO, JEAN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN MARIE
Middle Name:
Last Name:SANJURJO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2207
Mailing Address - Country:US
Mailing Address - Phone:917-716-7812
Mailing Address - Fax:
Practice Address - Street 1:1313 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4338
Practice Address - Country:US
Practice Address - Phone:718-273-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084010512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist