Healthcare Provider Details

I. General information

NPI: 1205939774
Provider Name (Legal Business Name): IRVING DJENG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2929 KLOCKNER RD
HAMILTON SQUARE NJ
08690-2809
US

IV. Provider business mailing address

2929 KLOCKNER RD
HAMILTON SQUARE NJ
08690-2809
US

V. Phone/Fax

Practice location:
  • Phone: 609-586-6603
  • Fax: 609-586-1801
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2060700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: