MEDICARE: JERSEY HEIGHTS DENTAL CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1831815547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERSEY HEIGHTS DENTAL CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 705
Second Line	:
City	:	EASTON
State	:	MD
Zip	:	21601-8912
Country	:	US
Telephone Number	:	410-200-0286
Fax Number	:	410-822-0577

Provider Business Practice Location Address
First Line	:	3524 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3448
Country	:	US
Telephone Number	:	201-484-7474
Fax Number	:	210-473-7040

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	JUDITH S DEBORJA
Credential	:
Telephone Number	:	410-200-0286

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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