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NPI Code Detail

MEDICARE: DR. JONATHAN S UNGAR DMD

MEDICARE: DR. JONATHAN S UNGAR DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry22DI02263800NJ
21223G0001XGeneral Practice Dentistry051567-1NY

General Provider Information

NPI Number : 1790821262
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN S UNGAR DMD
Provider Business Mailing Address
First Line : 110 HILLSIDE BLVD STE 5
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-3394
Country : US
Telephone Number : 732-333-3383
Fax Number : 815-301-9612
Provider Business Practice Location Address
First Line : 110 HILLSIDE BLVD STE 5
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-3394
Country : US
Telephone Number : 732-333-3383
Fax Number : 815-301-9612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 11/21/2016

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