Healthcare Provider Details

I. General information

NPI: 1942262068
Provider Name (Legal Business Name): TALIB A, NAJJAR DMD,MDS,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BERGEN ST
NEWARK NJ
07103-2495
US

IV. Provider business mailing address

110 BERGEN ST
NEWARK NJ
07103-2495
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4636
  • Fax: 973-972-4899
Mailing address:
  • Phone: 973-972-4636
  • Fax: 973-972-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9779
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: