Provider Demographics
NPI:1417153487
Name:JACKIER, H KENNETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:KENNETH
Last Name:JACKIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7660
Mailing Address - Country:US
Mailing Address - Phone:212-319-8009
Mailing Address - Fax:212-421-0410
Practice Address - Street 1:220 E 63RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7660
Practice Address - Country:US
Practice Address - Phone:212-319-8009
Practice Address - Fax:212-421-0410
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist