Provider Demographics
NPI:1982835948
Name:JACOB, RESHMA (DDS, MS)
Entity type:Individual
Prefix:
First Name:RESHMA
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MADISON AVE RM 1800
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1152
Mailing Address - Country:US
Mailing Address - Phone:212-868-4657
Mailing Address - Fax:212-704-8355
Practice Address - Street 1:425 MADISON AVE RM 1800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1152
Practice Address - Country:US
Practice Address - Phone:212-868-4657
Practice Address - Fax:212-704-8355
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125771223G0001X
NY0558951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice