Provider Demographics
NPI:1386881621
Name:JACOBSKIND, NORMAN DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:DAVID
Last Name:JACOBSKIND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MERRIFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2944
Mailing Address - Country:US
Mailing Address - Phone:516-766-7400
Mailing Address - Fax:516-766-0020
Practice Address - Street 1:400 MERRIFIELD AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2944
Practice Address - Country:US
Practice Address - Phone:516-766-7400
Practice Address - Fax:516-766-0020
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0387211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice