Individual
JORDAN LISSAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3767 HYLAN BLVD, STATEN ISLAND, NY 10308-3505
(718) 966-2720
Mailing address
3767 HYLAN BLVD, STATEN ISLAND, NY 10308-3505
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
055112
NY
Other
Enumeration date
07/27/2011
Last updated
04/06/2020
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