Healthcare Provider Details

I. General information

NPI: 1336356609
Provider Name (Legal Business Name): JAMIE SETH GARTENBERG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 N TRIPHAMMER RD SUITE 502
ITHACA NY
14850-1082
US

IV. Provider business mailing address

2333 N TRIPHAMMER RD SUITE 502
ITHACA NY
14850-1082
US

V. Phone/Fax

Practice location:
  • Phone: 607-257-0539
  • Fax:
Mailing address:
  • Phone: 607-257-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number046052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: