Provider Demographics
NPI:1023321106
Name:JAIN, PAYAL (DDS)
Entity type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:
Last Name:JAIN
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 1:1517 HUDSON PARK
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1572
Mailing Address - Country:US
Mailing Address - Phone:203-219-0285
Mailing Address - Fax:
Practice Address - Street 1:2660 MAIN ST
Practice Address - Street 2:# 217
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5362
Practice Address - Country:US
Practice Address - Phone:203-219-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice