Provider Demographics
NPI:1952381279
Name:EFRON, JOEL R (DMD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:EFRON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2114
Mailing Address - Country:US
Mailing Address - Phone:908-725-8806
Mailing Address - Fax:908-725-8203
Practice Address - Street 1:85 W HIGH ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2114
Practice Address - Country:US
Practice Address - Phone:908-725-8806
Practice Address - Fax:908-725-8203
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012960011223S0112X
NJ22DI012960001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U07576Medicare UPIN
NJ188324Medicare ID - Type Unspecified