Organization
LDFCB DENTISTRY
Active
Other names
Pediatric Dentistry on Avenue U
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY L JACOBSON DMD (CREDENTIALING SPECIALIST)
(845) 369-3703
Entity
Organization
Contact information
Practice address
817 AVENUE U, BROOKLYN, NY 11223-4135
(718) 375-1700
(718) 375-3375
Mailing address
29 N AIRMONT RD STE 22, SUFFERN, NY 10901-4242
(845) 369-3703
(845) 369-3183
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
07/19/2022
Last updated
07/12/2023
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