Healthcare Provider Details

I. General information

NPI: 1831815547
Provider Name (Legal Business Name): JERSEY HEIGHTS DENTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07307-3448
US

IV. Provider business mailing address

PO BOX 705
EASTON MD
21601-8912
US

V. Phone/Fax

Practice location:
  • Phone: 201-484-7474
  • Fax: 210-473-7040
Mailing address:
  • Phone: 410-200-0286
  • Fax: 410-822-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH S DEBORJA
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 410-200-0286