Provider Demographics
NPI:1821185612
Name:STEPHENSON BUFFONG, JEANNINE (DMD)
Entity type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:
Last Name:STEPHENSON BUFFONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JEANNINE
Other - Middle Name:
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1700 MYRTLE AVE
Mailing Address - Street 2:58
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07063-1000
Mailing Address - Country:US
Mailing Address - Phone:908-753-6401
Mailing Address - Fax:908-226-6743
Practice Address - Street 1:1700 MYRTLE AVE
Practice Address - Street 2:58
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07063-1000
Practice Address - Country:US
Practice Address - Phone:908-753-6401
Practice Address - Fax:908-226-6743
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0225621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0252212Medicaid