Organization
PEDIATRIC DENTISTRY OF ALBANY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY L JACOBSON DMD (CEO)
(845) 369-3703
Entity
Organization
Contact information
Practice address
980 WESTERN AVE, ALBANY, NY 12203-2799
(518) 512-3072
(518) 621-7286
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
03/21/2013
Last updated
07/11/2023
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