Provider Demographics
NPI:1053473280
Name:BRIAN JAGIRDAR DMD,PA
Entity type:Organization
Organization Name:BRIAN JAGIRDAR DMD,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAGIRDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-205-9500
Mailing Address - Street 1:70 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4851
Mailing Address - Country:US
Mailing Address - Phone:856-205-9500
Mailing Address - Fax:856-507-1020
Practice Address - Street 1:70 S STATE ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4851
Practice Address - Country:US
Practice Address - Phone:856-205-9500
Practice Address - Fax:856-507-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO182371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty