Jonathan M Abenaim, DMD
Individual provider Active NPI Dentist · Hawthorne, NJ
NPI 1578617528 · NPPES record last updated Feb 15, 2022
Key facts
- NPI
- 1578617528
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 22DI02335100 (NJ)
- Practice address
- 1111 Goffle Rd
Hawthorne, NJ 07506-2025 - Phone
- (973) 423-4460
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02335100 | NJ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jonathan Dental Spa at the Center for Cosmetic & Implant Dentistry LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02335100 | NJ | Yes |
Addresses
Primary practice location
1111 Goffle Rd
Hawthorne, NJ 07506-2025
Mailing address
1111 Goffle Rd
Hawthorne, NJ 07506-2025
Phone (973) 423-4460
Other providers in Hawthorne, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.