Jacob a. Avner, DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0496891 Issued in NY

Legal business name

JACOB A. AVNER, DDS PC

Practice address

9725 64TH Ave
Unit: G-3
Rego Park, NY 11374-2236

Phone

(718) 275-7300

Fax

(718) 275-7307

NPI assigned

Oct 7, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jacob Avner, DDSNPI 1851434021

Title

Dentist/Owner

Phone

(718) 275-7300

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Great Smiles of NY Doing business as

Locations

Practitioners 1

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

• Jacob Alayev Avner, DDS

  • General Practice Dentistry
  • Rego Park, NY
  • NPI 1851434021
  NPD (past) Authorized official

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1114398807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9725 64TH AVE",
            "address_2": "UNIT: G-3",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742236",
            "telephone_number": "718-275-7300",
            "fax_number": "718-275-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9725 64TH AVE",
            "address_2": "UNIT: G-3",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742236",
            "telephone_number": "718-275-7300",
            "fax_number": "718-275-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOB A. AVNER, DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "AVNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "718-275-7300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0496891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02282222",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Smiles of NY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nadya Izik, RN
• Khusni Izrailova, PHARMD
• Rebecca Izrailova
• Susana Izrailova, N.P.
• Laurie Ann Jackson, LCSW R
• Arlene Marie Jacobi, RD
• Julia Jacobs
• Andrei-Claudian Jaeger, MD
• Sylvia Jaeger, LCSW
• Mariae Patrice Hernandez Jael, PT

• General Practice Dentistry in Rego Park, NY
• Providers in Rego Park, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; 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.