Provider Demographics
NPI:1932537040
Name:JERSEY CITY PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:JERSEY CITY PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-434-3000
Mailing Address - Street 1:139 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2811
Mailing Address - Country:US
Mailing Address - Phone:201-434-3000
Mailing Address - Fax:201-434-3001
Practice Address - Street 1:139 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2811
Practice Address - Country:US
Practice Address - Phone:201-434-3000
Practice Address - Fax:201-434-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO23564031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty