Provider Demographics
NPI:1033395934
Name:NEW JERSEY LASER DENTISTRY
Entity Type:Organization
Organization Name:NEW JERSEY LASER DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-837-1612
Mailing Address - Street 1:751 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4242
Mailing Address - Country:US
Mailing Address - Phone:201-837-1612
Mailing Address - Fax:201-837-8651
Practice Address - Street 1:751 TEANECK RD
Practice Address - Street 2:C/0 DR JACOBSON 3RD FLOOR
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4242
Practice Address - Country:US
Practice Address - Phone:201-837-1612
Practice Address - Fax:201-837-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19069261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental