Provider Demographics
NPI:1467510636
Name:BARRY ORTENBERG GARY P JABLOW CHARLES A BAKER DDS PC
Entity Type:Organization
Organization Name:BARRY ORTENBERG GARY P JABLOW CHARLES A BAKER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-736-2525
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727
Mailing Address - Country:US
Mailing Address - Phone:631-736-2525
Mailing Address - Fax:631-736-6825
Practice Address - Street 1:248 260 MIDDLE COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-0449
Practice Address - Country:US
Practice Address - Phone:631-736-2525
Practice Address - Fax:631-736-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty