Provider Demographics
NPI:1164044210
Name:ALTMIRE, JACOB JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JEFFREY
Last Name:ALTMIRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 LAKE POINT DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9586
Mailing Address - Country:US
Mailing Address - Phone:585-747-0291
Mailing Address - Fax:
Practice Address - Street 1:39 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2933
Practice Address - Country:US
Practice Address - Phone:585-872-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0627451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry