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General NPI Number Information
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NPI Number | 1114595352
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Entity Type | Organization
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Legal Business Name | JESSICA N MADRID DENTISTRY P.C.
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 4 WHITTIER ST
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City | LYNBROOK
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State | NY
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Zip | 11563-1018
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Country | US
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Telephone | 516-754-0430
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Fax |
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Provider Business Mailing Address
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Address Line | 4 WHITTIER ST
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City | LYNBROOK
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State | NY
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Zip | 11563-1018
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Country | US
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Telephone | 516-754-0430
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Fax |
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. JESSICA N MADRID
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Credential | DDS
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Telephone | 516-754-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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