Provider Demographics
NPI:1770790107
Name:CARDINALE, JACLYN COURTNEY (DMD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:COURTNEY
Last Name:CARDINALE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1202
Mailing Address - Country:US
Mailing Address - Phone:551-697-0948
Mailing Address - Fax:
Practice Address - Street 1:1979 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1202
Practice Address - Country:US
Practice Address - Phone:551-697-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02342200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist