Provider Demographics
NPI:1265294052
Name:CLARKSTOWN DENTAL PRACTICE PC
Entity type:Organization
Organization Name:CLARKSTOWN DENTAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JABBARY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-267-8686
Mailing Address - Street 1:285 N ROUTE 303 STE 11
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1425
Mailing Address - Country:US
Mailing Address - Phone:845-267-8686
Mailing Address - Fax:845-268-2870
Practice Address - Street 1:285 N ROUTE 303 STE 11
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-1425
Practice Address - Country:US
Practice Address - Phone:845-267-8686
Practice Address - Fax:845-268-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty