Pediatric Dentistry of Kingston PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTISTRY OF KINGSTON PLLC

Doing business as

Pediatric Dentistry of Kingston

Practice address

169 Washinghton Ave
Kingston, NY 12401

Phone

(845) 514-2255

Fax

(845) 514-2292

NPI assigned

Feb 20, 2013

Last updated

Jul 12, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Barry L Jacobson, DMDNPI 1538279625

Title

Owner

Phone

(845) 369-3703

Specialties & licenses 5

Addresses

Other names 1

• Pediatric Dentistry of Kingston Doing business as

Tax ID family

Pediatric Dentistry of Catskill2 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.

• Pediatric Dentistry of Kingston PLLC

  dba Pediatric Dentistry of Catskill

  • Pediatric Dentistry
  • Catskill, NY
  • NPI 1346975877
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Barry L. Jacobson, DMD

  • Pediatric Dentistry
  • Flushing, NY
  • NPI 1538279625
  Authorized official Same address or phone

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

{
    "created_epoch": "1361318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1053651554",
    "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": "169 WASHINGHTON AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-514-2255",
            "fax_number": "845-514-2292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF KINGSTON PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-20",
        "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": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry of Kingston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deepak Rameshchandra Patel, MD
• Mukesh Patel, DDS
• Shalin Jitendra Patel, M.D.
• Patricia D Payette
• Amber L Pease, RN
• Laurel Pelzek, LCSW-R
• People Incorporated
• Valerie Percy, CCC-SLP
• Ayse Pere, N.P.
• Divine Emilio Perez-Ferreira

• Pediatric Dentistry in Kingston, NY
• Providers in Kingston, NY by specialty
• Pediatric Dentistry in New York

• 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.