Provider Demographics
NPI:1942262068
Name:NAJJAR, TALIB A, (DMD,MDS,PHD)
Entity Type:Individual
Prefix:DR
First Name:TALIB
Middle Name:A,
Last Name:NAJJAR
Suffix:
Gender:M
Credentials:DMD,MDS,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2495
Mailing Address - Country:US
Mailing Address - Phone:973-972-4636
Mailing Address - Fax:973-972-4899
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-4636
Practice Address - Fax:973-972-4899
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ97791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD00000119Medicare ID - Type UnspecifiedDENTIS/ORAL&MAXILLOFACIAL