# JACLYN KIRSHBAUM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1598419079
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 22DI03065000 | NJ | Yes |
| 1223P0221X | Pediatric Dentistry | LL908 | MD | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | — | — |

## Other

- **Enumeration date:** 02/04/2022
- **Last updated:** 09/23/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 119591300 | — | MD |