Provider Demographics
NPI:1912139387
Name:ETESS, JEFFREY MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARC
Last Name:ETESS
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 1:25 COVES RUN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-1008
Mailing Address - Country:US
Mailing Address - Phone:516-938-4987
Mailing Address - Fax:
Practice Address - Street 1:245 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2240
Practice Address - Country:US
Practice Address - Phone:516-253-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47537-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics