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Individual

AUSTIN JOLY JACOB

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
123 S PAVILION AVE, RIVERSIDE, NJ 08075-3611
(856) 393-8510
Mailing address
123 S PAVILION AVE, RIVERSIDE, NJ 08075-3611
(856) 393-8510

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02940800
NJ
122300000X
Dentist
Primary
DS043994
PA

Other

Enumeration date
12/01/2022
Last updated
02/18/2025
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