North Country Pediatric Dentistry PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

NORTH COUNTRY PEDIATRIC DENTISTRY PLLC

Practice address

447 E Main St
Malone, NY 12953-2126

Phone

(518) 483-0100

Fax

(518) 483-0101

NPI assigned

Jul 19, 2022

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, DMD

Title

Owner

Phone

(845) 369-3703

Specialties & licenses 5

Addresses

Other names 1

• Pediatric Dentistry of Malone Doing business as

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.

• North Country Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Plattsburgh, NY
  • NPI 1003232463
  NPD tax ID

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": "1821723362",
    "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": "447 E MAIN ST",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129532126",
            "telephone_number": "518-483-0100",
            "fax_number": "518-483-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH COUNTRY PEDIATRIC DENTISTRY PLLC",
        "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": "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 Malone",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Dentistry of Malone",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Jeanne Nicholas
• Jonathan Nitschke
• Janice Nolan Norcross
• Wendy Rae Norman, MPT
• North Country Health Care, Medical PLLC
• North Country Precision Medical Imaging, PC
• Northeast Medical Equipment Inc
• Northern Ambulance Corps, LLC
• Dylan O'Connor
• Elizabeth Lucille O'Connor, RN

• Pediatric Dentistry in Malone, NY
• Providers in Malone, 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.