Individual
DR. LISA ANN JEDACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MPH
Contact information
Practice address
1400 PELHAM PKWY S, BRONX, NY 10461-1197
(718) 918-5000
Mailing address
1817 MAYFLOWER AVE, BRONX, NY 10461-4103
(440) 665-3973
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401418721
VA
122300000X
Dentist
22DI03015700
NJ
122300000X
Dentist
2901602093
MI
122300000X
Dentist
30.027607
OH
122300000X
Dentist
DN10000315
MA
1223D0004X
Dental Anesthesiology
Primary
0401418721
VA
1223D0004X
Dental Anesthesiology
2901602093
MI
1223D0004X
Dental Anesthesiology
30.027607
OH
1223D0004X
Dental Anesthesiology
DN10000315
MA
Other
Enumeration date
02/09/2021
Last updated
07/09/2024
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