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General NPI Number Information
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NPI Number | 1538279625
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Entity Type | Individual
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Provider Name | BARRY L. JACOBSON DMD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 135-14 JEWEL AVE
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City | FLUSHING
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State | NY
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Zip | 11367
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Country | US
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Telephone | 718-997-6453
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Fax | 718-793-8956
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Provider Business Mailing Address
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Address Line | 29 N AIRMONT RD STE 22
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City | SUFFERN
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State | NY
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Zip | 10901-4242
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Country | US
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Telephone | 845-369-3703
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Fax | 845-369-3183
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 045485
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License Number State | NY
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