Provider Demographics
NPI:1558682294
Name:ZOBEL, JEREMY J (DDS)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:J
Last Name:ZOBEL
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 1:2333 N TRIPHAMMER RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1082
Mailing Address - Country:US
Mailing Address - Phone:607-257-0078
Mailing Address - Fax:607-266-7815
Practice Address - Street 1:2333 N TRIPHAMMER RD
Practice Address - Street 2:SUITE 303
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1082
Practice Address - Country:US
Practice Address - Phone:607-257-0078
Practice Address - Fax:607-266-7815
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435809099Medicaid