Provider Demographics
NPI:1801063854
Name:SINGH, PRABHJOT (DDS)
Entity type:Individual
Prefix:DR
First Name:PRABHJOT
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CONSTITUTION AVE
Mailing Address - Street 2:APT 401
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-339-4546
Mailing Address - Fax:
Practice Address - Street 1:1030 ST. GEORGES AVE
Practice Address - Street 2:ROOM B-854
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001
Practice Address - Country:US
Practice Address - Phone:732-750-3600
Practice Address - Fax:732-750-3696
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI023133001223G0001X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice