Provider Demographics
NPI:1801049234
Name:TJONAJONG, SIEGFRIED WILLEM (DMD MSD)
Entity type:Individual
Prefix:
First Name:SIEGFRIED
Middle Name:WILLEM
Last Name:TJONAJONG
Suffix:
Gender:M
Credentials:DMD MSD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:947 LINWOOD AVENUE SUITE 1 NORTH
Mailing Address - Street 2:ORAL & MAXILLOFACIAL PROSTHODONTICS
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-670-4800
Mailing Address - Fax:201-670-6776
Practice Address - Street 1:947 LINWOOD AVE STE 1
Practice Address - Street 2:ORAL & MAXILLOFACIAL PROSTHODONTICS
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2939
Practice Address - Country:US
Practice Address - Phone:201-670-4800
Practice Address - Fax:201-670-6776
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ22DIO1785000122300000X
NJNJ-38071223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics