Provider Demographics
NPI:1538214630
Name:GIGNAC, JEAN-MICHEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JEAN-MICHEL
Middle Name:
Last Name:GIGNAC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3024
Mailing Address - Country:US
Mailing Address - Phone:973-627-8900
Mailing Address - Fax:973-627-9597
Practice Address - Street 1:20 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3024
Practice Address - Country:US
Practice Address - Phone:973-627-8900
Practice Address - Fax:973-627-9597
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ166791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice