Individual
JACLYN KIRSHBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
140 MARKET ST FL 2, PATERSON, NJ 07505-1471
(973) 742-4200
Mailing address
140 MARKET ST FL 2, PATERSON, NJ 07505-1471
(973) 742-4200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI03065000
NJ
1223P0221X
Pediatric Dentistry
LL908
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119591300
—
MD
Enumeration date
02/04/2022
Last updated
09/23/2024
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