Provider Demographics
NPI:1235244815
Name:JASLOW, BRUCE MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARTIN
Last Name:JASLOW
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 1:26 PINE RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:OLD BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1118
Mailing Address - Country:US
Mailing Address - Phone:516-626-0100
Mailing Address - Fax:
Practice Address - Street 1:26 PINE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:OLD BROOKVILLE
Practice Address - State:NY
Practice Address - Zip Code:11548-1118
Practice Address - Country:US
Practice Address - Phone:516-626-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist