Provider Demographics
NPI:1992904437
Name:SMALLBERG, JORDANA DIANE (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDANA
Middle Name:DIANE
Last Name:SMALLBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WINTHROP ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 WINTHROP ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3388
Practice Address - Country:US
Practice Address - Phone:516-997-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053021122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice