Healthcare Provider Details

I. General information

NPI: 1821403684
Provider Name (Legal Business Name): JESSICA KAGAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ZILO DDS

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 01/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N. ST RD #1
BRIARCLIFF MANOR NY
10510
US

IV. Provider business mailing address

401 E. 89TH ST 1K
NEW YORK NY
10128
US

V. Phone/Fax

Practice location:
  • Phone: 561-543-4023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number058050
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: