Provider Demographics
NPI:1801268420
Name:PIATNICHOUK, JURGITA (DMD)
Entity type:Individual
Prefix:MRS
First Name:JURGITA
Middle Name:
Last Name:PIATNICHOUK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JURGITA
Other - Middle Name:
Other - Last Name:PIATNICHOUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:37 WEATHERVANE CIR
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-2535
Mailing Address - Country:US
Mailing Address - Phone:718-644-9722
Mailing Address - Fax:
Practice Address - Street 1:3003 ENGLISH CREEK AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4863
Practice Address - Country:US
Practice Address - Phone:609-484-5996
Practice Address - Fax:609-484-1715
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02610600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist