Healthcare Provider Details

I. General information

NPI: 1588015382
Provider Name (Legal Business Name): JENNIFER DOBZANSKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 KLOCKNER RD
HAMILTON NJ
08690-2809
US

IV. Provider business mailing address

2001 HAMILTON ST APT 2214
PHILADELPHIA PA
19130-4209
US

V. Phone/Fax

Practice location:
  • Phone: 609-586-6603
  • Fax: 609-528-3003
Mailing address:
  • Phone: 215-262-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02696400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: