Provider Demographics
NPI:1811169535
Name:JESSICA LOO MARN, DDS, PC
Entity type:Organization
Organization Name:JESSICA LOO MARN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST / BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOO MARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-965-8113
Mailing Address - Street 1:128 MOTT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5540
Mailing Address - Country:US
Mailing Address - Phone:212-965-8113
Mailing Address - Fax:212-965-8114
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:212-965-8113
Practice Address - Fax:212-965-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health