Provider Demographics
NPI:1346438991
Name:SCHWARTZ, JACK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:SCHWARTZ
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 1:134 W 58TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2146
Mailing Address - Country:US
Mailing Address - Phone:212-582-6617
Mailing Address - Fax:212-586-3114
Practice Address - Street 1:134 W 58TH ST STE 105
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2146
Practice Address - Country:US
Practice Address - Phone:212-582-6617
Practice Address - Fax:212-586-3114
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice