Organization
JACKSON PEDIATRIC DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE MIKHLY DDS (OWNER)
(917) 974-8445
Entity
Organization
Contact information
Practice address
2064 W COUNTY LINE RD, JACKSON, NJ 08527-2014
(732) 637-9805
Mailing address
2064 W COUNTY LINE RD, JACKSON, NJ 08527-2014
(732) 637-9805
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22DI02529300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22DI02529300
DENTAL LICENSE
NJ
Enumeration date
06/21/2018
Last updated
06/21/2018
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