Healthcare Provider Details

I. General information

NPI: 1033112578
Provider Name (Legal Business Name): JARRETT ALLAN PIKSER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 DEER PARK AVE
DEER PARK NY
11729-2119
US

IV. Provider business mailing address

2100 DEER PARK AVE
DEER PARK NY
11729-2119
US

V. Phone/Fax

Practice location:
  • Phone: 634-242-0404
  • Fax:
Mailing address:
  • Phone: 634-242-0404
  • Fax: 631-242-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number028978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: