Provider Demographics
NPI:1255334165
Name:JIN, DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 ANDERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1732
Mailing Address - Country:US
Mailing Address - Phone:201-224-4400
Mailing Address - Fax:201-224-4418
Practice Address - Street 1:1315 ANDERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-1732
Practice Address - Country:US
Practice Address - Phone:201-224-4400
Practice Address - Fax:201-224-4418
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047558-1122300000X
NJ22DI021836001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice