Provider Demographics
NPI:1053582106
Name:JB DENTAL PC
Entity type:Organization
Organization Name:JB DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARONE
Authorized Official - Middle Name:RACHAL
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-968-7023
Mailing Address - Street 1:3410 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7400
Mailing Address - Country:US
Mailing Address - Phone:212-283-7670
Mailing Address - Fax:212-283-7832
Practice Address - Street 1:3410 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7400
Practice Address - Country:US
Practice Address - Phone:212-283-7670
Practice Address - Fax:212-283-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361931223G0001X
NY0510141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty