=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952469322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAIRFIELD DENTAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 193 FAIRFIELD RD
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07004-2472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-227-0650
-----------------------------------------------------
Fax | 973-227-8148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 193 FAIRFIELD RD
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07004-2472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-227-0650
-----------------------------------------------------
Fax | 973-227-8148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNTS MANGER
-----------------------------------------------------
Name | JILL SEBILIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-227-0650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 22616
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 21585
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 11780
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 21633
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22353
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 21981
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 18734
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 19847
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 21526
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------