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General NPI Number Information
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NPI Number | 1801049234
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Entity Type | Individual
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Provider Name | SIEGFRIED WILLEM TJONAJONG DMD MSD
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Gender | Male
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 947 LINWOOD AVE STE 1 ORAL & MAXILLOFACIAL PROSTHODONTICS
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2939
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Country | US
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Telephone | 201-670-4800
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Fax | 201-670-6776
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Provider Business Mailing Address
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Address Line | 947 LINWOOD AVENUE SUITE 1 NORTH ORAL & MAXILLOFACIAL PROSTHODONTICS
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-670-4800
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Fax | 201-670-6776
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22DIO1785000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | NJ-3807
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License Number State | NJ
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