Individual
JACOB POURAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
1137 PALISADE AVE, FORT LEE, NJ 07024-6427
(201) 224-8180
Mailing address
194 HARWOOD PL, PARAMUS, NJ 07652-4606
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI02914400
NJ
Other
Enumeration date
06/30/2022
Last updated
06/30/2022
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