Individual
AMARILIS JACOBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
131 W 110TH ST, NEW YORK, NY 10026-4202
(212) 678-1944
(121) 666-6857
Mailing address
131 W 110TH ST, NEW YORK, NY 10026-4202
(212) 678-1944
(121) 666-6857
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
45577-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01526076
—
NY
Enumeration date
12/22/2005
Last updated
05/26/2021
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