Provider Demographics
NPI:1316036577
Name:SINGER, JACK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:SINGER
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 1:647 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4150
Mailing Address - Country:US
Mailing Address - Phone:516-249-6665
Mailing Address - Fax:516-293-3518
Practice Address - Street 1:647 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4150
Practice Address - Country:US
Practice Address - Phone:516-249-6665
Practice Address - Fax:516-293-3518
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036452-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00956607Medicaid