Provider Demographics
NPI:1184271165
Name:JERSEY DENTAL
Entity type:Organization
Organization Name:JERSEY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:SYED
Authorized Official - Last Name:SADIQ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-893-5200
Mailing Address - Street 1:4917 STELTON ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080
Mailing Address - Country:US
Mailing Address - Phone:908-753-9901
Mailing Address - Fax:908-753-9101
Practice Address - Street 1:4917 STELTON ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080
Practice Address - Country:US
Practice Address - Phone:908-753-9901
Practice Address - Fax:908-753-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty