Provider Demographics
NPI:1568509149
Name:CANTER, JOSHUA JAY (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAY
Last Name:CANTER
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 1:1607 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1824
Mailing Address - Country:US
Mailing Address - Phone:718-972-2970
Mailing Address - Fax:718-338-2449
Practice Address - Street 1:1607 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1824
Practice Address - Country:US
Practice Address - Phone:718-972-2970
Practice Address - Fax:718-338-2449
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0421081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01635405Medicaid
NYD000158-1OtherAMERICHOICE