Healthcare Provider Details

I. General information

NPI: 1154424018
Provider Name (Legal Business Name): IVETTE DAUHAJRE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 KENNEDY BLVD E
GUTTENBERG NJ
07093-4818
US

IV. Provider business mailing address

7000 KENNEDY BLVD E
GUTTENBERG NJ
07093-4818
US

V. Phone/Fax

Practice location:
  • Phone: 201-868-2882
  • Fax: 201-868-2865
Mailing address:
  • Phone: 201-868-2882
  • Fax: 201-868-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI16781
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: