Provider Demographics
NPI:1336458348
Name:HALPER, JODI I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:I
Last Name:HALPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11055 72ND RD
Mailing Address - Street 2:SUITE L-1
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5472
Mailing Address - Country:US
Mailing Address - Phone:718-268-1028
Mailing Address - Fax:718-263-0701
Practice Address - Street 1:11055 72ND RD
Practice Address - Street 2:SUITE L-1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5472
Practice Address - Country:US
Practice Address - Phone:718-268-1028
Practice Address - Fax:718-263-0701
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0447681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice