Individual
LAURANCE JERROLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
96 ASPEN DRIVE EAST, WOODBURY, NY 11797
(904) 710-5125
Mailing address
96 ASPEN DRIVE EAST, WOODBURY, NY 11797
(904) 710-5125
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
032081
NY
Other
Enumeration date
12/05/2013
Last updated
11/30/2021
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