Individual
DR. JAY LACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
200 MONUMENT ROAD, SUITE #4, BALA CYNWYD, PA 19004-1726
(610) 667-7405
(610) 667-7409
Mailing address
200 MONUMENT RD, SUITE #4, BALA CYNWYD, PA 19004-1726
(610) 667-7405
(610) 667-7409
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS017812L
PA
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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