Provider Demographics
NPI:1336351212
Name:DENTAL CENTER OF JERSEY CITY
Entity Type:Organization
Organization Name:DENTAL CENTER OF JERSEY CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-333-6900
Mailing Address - Street 1:231 OLD BERGEN RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2620
Mailing Address - Country:US
Mailing Address - Phone:201-333-6900
Mailing Address - Fax:201-333-6360
Practice Address - Street 1:231 OLD BERGEN RD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2620
Practice Address - Country:US
Practice Address - Phone:201-333-6900
Practice Address - Fax:201-333-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0=========OtherMETLIFE INSURANCE