Provider Demographics
NPI:1700967981
Name:JERSEY DENTAL ARTS PA
Entity Type:Organization
Organization Name:JERSEY DENTAL ARTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SONBOLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-946-1000
Mailing Address - Street 1:846 BERGEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-946-1000
Mailing Address - Fax:201-946-1641
Practice Address - Street 1:846 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4404
Practice Address - Country:US
Practice Address - Phone:201-946-1000
Practice Address - Fax:201-946-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ188391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6535802Medicaid