Provider Demographics
NPI:1255642062
Name:JR DENTAL LLC
Entity type:Organization
Organization Name:JR DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-960-5790
Mailing Address - Street 1:8 BALDWIN AVE
Mailing Address - Street 2:#2B
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-3154
Mailing Address - Country:US
Mailing Address - Phone:201-432-6000
Mailing Address - Fax:973-669-0551
Practice Address - Street 1:8 BALDWIN AVE
Practice Address - Street 2:#2B
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3154
Practice Address - Country:US
Practice Address - Phone:201-432-6000
Practice Address - Fax:973-669-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014390001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty