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General NPI Number Information
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NPI Number | 1386845154
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Entity Type | Organization
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Legal Business Name | NORTHFIELD FAMILY DENTAL GROUP
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1423 TILTON RD STE 2
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City | NORTHFIELD
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State | NJ
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Zip | 08225
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Country | US
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Telephone | 609-646-9100
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Fax | 609-646-3016
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Provider Business Mailing Address
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Address Line | 1423 TILTON RD SUITE 2
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City | NORTHFIELD
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State | NJ
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Zip | 08225
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Country | US
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Telephone | 609-646-9100
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Fax | 609-646-3016
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | KENNETH L JAGGER
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Credential | DDS
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Telephone | 609-646-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI01139300
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License Number State | NJ
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