Provider Demographics
NPI:1942441365
Name:PERCYZ, JARED SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:SCOTT
Last Name:PERCYZ
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 1:10 HUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2714
Mailing Address - Country:US
Mailing Address - Phone:631-821-3838
Mailing Address - Fax:631-821-8022
Practice Address - Street 1:10 HUNTER AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2714
Practice Address - Country:US
Practice Address - Phone:631-821-3838
Practice Address - Fax:631-821-8022
Is Sole Proprietor?:No
Enumeration Date:2009-03-14
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009801122300000X
NY054020-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY054020-1OtherNY STATE LICENSE
11-3219999OtherTAX ID NUMBER FOR PC