Individual
JESSICA MARIE LAVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
722 W 168TH ST, NEW YORK, NY 10032-3727
(212) 305-6754
Mailing address
722 W 168TH ST, NEW YORK, NY 10032-3727
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
062528
NY
Other
Enumeration date
02/06/2020
Last updated
05/29/2023
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