Organization
KNICKERBOCKER FAMILY DENTAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY D JACOBS (CHIEF OPERATING OFFICER)
(718) 574-0527
Entity
Organization
Contact information
Practice address
214 STANHOPE ST, BROOKLYN, NY 11237-4202
(718) 574-0527
(718) 715-0624
Mailing address
214 STANHOPE ST, BROOKLYN, NY 11237-4202
(718) 574-0527
(718) 715-0624
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
039714
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037914
NYS DENTAL LICENSE
NY
Enumeration date
03/04/2007
Last updated
08/22/2020
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