Provider Demographics
NPI:1619986395
Name:SYLVESTER, JOHN M (DMD,FAGD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:DMD,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2336
Mailing Address - Country:US
Mailing Address - Phone:973-822-3819
Mailing Address - Fax:973-822-1922
Practice Address - Street 1:330 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2336
Practice Address - Country:US
Practice Address - Phone:973-822-3819
Practice Address - Fax:973-822-1922
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ114091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice