Provider Demographics
NPI:1689863300
Name:KANNER, JED S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:S
Last Name:KANNER
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 1:53 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6148
Mailing Address - Country:US
Mailing Address - Phone:212-861-5500
Mailing Address - Fax:212-861-8437
Practice Address - Street 1:53 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6148
Practice Address - Country:US
Practice Address - Phone:212-861-5500
Practice Address - Fax:212-861-8437
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 037282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist