Organization
PEDIATRIC DENTISTRY ON PARK PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY L JACOBSON DMD (OWNER)
(212) 997-6453
Entity
Organization
Contact information
Practice address
949 PARK AVE, 1ST FLOOR, NEW YORK, NY 10028-0315
(212) 997-6453
Mailing address
949 PARK AVE, 1ST FLOOR, NEW YORK, NY 10028-0315
(212) 997-6453
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
02/06/2014
Last updated
07/13/2023
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