Provider Demographics
NPI:1972655017
Name:POPECK, JERRY J (DMD PC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:J
Last Name:POPECK
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 NORTH BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070
Mailing Address - Country:US
Mailing Address - Phone:856-678-6393
Mailing Address - Fax:856-678-6816
Practice Address - Street 1:133 NORTH BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070
Practice Address - Country:US
Practice Address - Phone:856-678-6393
Practice Address - Fax:856-678-6816
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-12-16
Deactivation Date:2012-01-18
Deactivation Code:
Reactivation Date:2014-12-16
Provider Licenses
StateLicense IDTaxonomies
NJDI0190211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice