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NPI Code Detail

MEDICARE: JDS DENTAL CARE PLLC

MEDICARE: JDS DENTAL CARE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223E0200XEndodontics
21223P0221XPediatric Dentistry
31223S0112XOral and Maxillofacial Surgery (Dentist)
4124Q00000XDental Hygienist
51223P0300XPeriodontics
6122300000XDentist

General Provider Information

NPI Number : 1922640630
Entity Type Code : Organization
Provider Name (Legal Business Name) : JDS DENTAL CARE PLLC
Provider Business Mailing Address
First Line : 15 OLIVER ST APT 2H
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-6511
Country : US
Telephone Number : 917-561-0539
Fax Number :
Provider Business Practice Location Address
First Line : 255 MASON AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3416
Country : US
Telephone Number : 718-987-6543
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JOSEPH ALBANESE
Credential : DMD
Telephone Number : 917-561-0539
Provider Enumeration Date : 10/14/2019
Last Update Date : 10/14/2019

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