Healthcare Provider Details

I. General information

NPI: 1922640630
Provider Name (Legal Business Name): JDS DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MASON AVE
STATEN ISLAND NY
10305-3416
US

IV. Provider business mailing address

15 OLIVER ST APT 2H
BROOKLYN NY
11209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-6543
  • Fax:
Mailing address:
  • Phone: 917-561-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH ALBANESE
Title or Position: OWNER
Credential: DMD
Phone: 917-561-0539