Provider Demographics
NPI:1326299181
Name:AMARILIS JACOBO DENTAL OFFICE PC
Entity Type:Organization
Organization Name:AMARILIS JACOBO DENTAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMARILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-678-1944
Mailing Address - Street 1:131 W 110TH ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-4202
Mailing Address - Country:US
Mailing Address - Phone:212-678-1944
Mailing Address - Fax:212-666-6857
Practice Address - Street 1:131 W 110TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-4202
Practice Address - Country:US
Practice Address - Phone:212-678-1944
Practice Address - Fax:212-666-6857
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMARILIS JACOBO DENTAL OFFICE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-09
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0455771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty