Provider Demographics
NPI:1083061899
Name:JURACKA, JOSEPH ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALAN
Last Name:JURACKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 S BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4558
Mailing Address - Country:US
Mailing Address - Phone:518-886-8610
Mailing Address - Fax:
Practice Address - Street 1:170 S BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4558
Practice Address - Country:US
Practice Address - Phone:518-886-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0408061223G0001X
NY0616141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice