Provider Demographics
NPI:1932366176
Name:MARKOS, JAISH JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:JAISH
Middle Name:JOHN
Last Name:MARKOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DAYTON LN
Mailing Address - Street 2:103
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2859
Mailing Address - Country:US
Mailing Address - Phone:914-402-6980
Mailing Address - Fax:
Practice Address - Street 1:50 DAYTON LN
Practice Address - Street 2:103
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2859
Practice Address - Country:US
Practice Address - Phone:914-402-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036252122300000X, 1223P0221X
NY0538501223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist