Provider Demographics
NPI:1952469322
Name:FAIRFIELD DENTAL GROUP
Entity Type:Organization
Organization Name:FAIRFIELD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBILIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-227-0650
Mailing Address - Street 1:193 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2472
Mailing Address - Country:US
Mailing Address - Phone:973-227-0650
Mailing Address - Fax:973-227-8148
Practice Address - Street 1:193 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2472
Practice Address - Country:US
Practice Address - Phone:973-227-0650
Practice Address - Fax:973-227-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ215851223E0200X
NJ226161223E0200X
NJ117801223G0001X
NJ216331223G0001X
NJ223531223G0001X
NJ219811223P0221X
NJ187341223P0300X
NJ198471223S0112X
NJ215261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty