NPIMap

Organization Active NPI

North Country Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Plattsburgh, NY
National Provider Identifier
1003232463
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
NORTH COUNTRY PEDIATRIC DENTISTRY PLLC
Practice address
55 Cornelia St
Plattsburgh, NY 12901-1853
Phone
(518) 566-0600
Fax
(518) 566-6602
NPI assigned
Mar 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barry L Jacobson, DMD
Title
Owner
Phone
(845) 369-3703

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dental AnesthesiologyGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0004X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

55 Cornelia St
Plattsburgh, NY 12901-1853

Mailing address

29 N Airmont Rd Ste 22
Suffern, NY 10901-4242
Phone (845) 369-3703

Other names 1

  • North Country Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
North Country Pediatric Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1003232463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 N AIRMONT RD STE 22",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109014242",
            "telephone_number": "845-369-3703",
            "fax_number": "845-369-3183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 CORNELIA ST",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011853",
            "telephone_number": "518-566-0600",
            "fax_number": "518-566-6602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH COUNTRY PEDIATRIC DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-369-3703",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Country Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plattsburgh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.