NPIMap

Organization Active NPI

Laser Dentistry for Children LLC

Doing business as Pediatric Dentistry of Valley Stream

  • Pediatric Dentistry
  • Valley Stream, NY
National Provider Identifier
1386379816
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
LASER DENTISTRY FOR CHILDREN LLC
Doing business as
Pediatric Dentistry of Valley Stream
Practice address
509 W Merrick Rd Ste 103
Valley Stream, NY 11580-5252
Phone
(516) 599-1701
Fax
(516) 599-1526
NPI assigned
Jul 19, 2022
Last updated
Jul 12, 2023By the provider in NPPES
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, DMDNPI 1538279625
Title
Owner
Phone
(845) 369-3703

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X
Pediatric Dentistry 1223P0221X Primary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
Dental Anesthesiology 1223D0004X

Addresses

Primary practice location

509 W Merrick Rd Ste 103
Valley Stream, NY 11580-5252

Mailing address

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

Other names 1

  • Pediatric Dentistry of Valley Stream Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Laser Dentistry for Children LLC2 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 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1658188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1386379816",
    "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": "509 W MERRICK RD STE 103",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115805252",
            "telephone_number": "516-599-1701",
            "fax_number": "516-599-1526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASER DENTISTRY FOR CHILDREN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-19",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry of Valley Stream",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Dentistry of Valley Stream",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valley Stream, 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.