Pediatric Dentistry of Albany, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTISTRY OF ALBANY, PLLC

Practice address

624 McClellan St Ste G03
Schenectady, NY 12304-1020

Phone

(518) 512-3072

Fax

(518) 621-7286

NPI assigned

Jul 11, 2023

Organization subpart

Yes

Parent organization

PEDIATRIC DENTISTRY OF ALBANY, PLLCAs reported in NPPES

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

Authorized official

Name

Dr. Barry L Jacobson, DMD

Title

Ceo

Phone

(845) 369-3703

Specialties & licenses 5

Addresses

Other names 1

• Pediatric Dentistry of Schenectady Doing business as

Tax ID family

Pediatric Dentistry of Albany PLLC3 organizations share this tax ID, including this one

Part of

Pediatric Dentistry of Albany PLLC

Other organizations with this tax ID 2

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

• Pediatric Dentistry of Albany, PLLC

  • Pediatric Dentistry
  • Schenectady, NY
  • NPI 1174202329
  NPD tax ID
• Pediatric Dentistry of Albany, PLLC

  • Pediatric Dentistry
  • Albany, NY
  • NPI 1881936441
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Pediatric Dentistry of Albany, PLLC

  • Pediatric Dentistry
  • Albany, NY
  • NPI 1881936441
  NPPES parent name

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1457039190",
    "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": "624 MCCLELLAN ST STE G03",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-512-3072",
            "fax_number": "518-621-7286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF ALBANY, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC DENTISTRY OF ALBANY, PLLC",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "845-369-3703",
        "authorized_official_name_prefix": "Dr.",
        "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": "Pediatric Dentistry of Schenectady",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Dentistry of Schenectady",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elyse S Pearson, M.D.
• Joshua G Peck, LCSW
• Laurie Nicole Peconie, MS CCC-SLP
• Megan Carol Pecunia, PHARM.D.
• Pediatric Dentistry of Albany, PLLC
• Estelle Marie Peek, RN
• Lorraine Elizabeth Peek, REGISTERED NURSE
• Tara Marie Peek, RN
• Bettina Andrea Pels-Wetzel, DDS
• James E Penk, LCSW-R

• Pediatric Dentistry in Schenectady, NY
• Providers in Schenectady, 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 18, 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.