Provider Demographics
NPI:1952741837
Name:KIMELMAN, JEFFREY A (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:KIMELMAN
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 1:123 EGG HARBOR RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9406
Mailing Address - Country:US
Mailing Address - Phone:856-227-8888
Mailing Address - Fax:856-227-8001
Practice Address - Street 1:123 EGG HARBOR RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9406
Practice Address - Country:US
Practice Address - Phone:856-227-8888
Practice Address - Fax:856-227-8001
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ161541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery