Basic Information
| Provider Information | |||||||||
| NPI: | 1740293752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOM | ||||||||
| FirstName: | JEFFERY | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13-17 ELIZABETH STREET | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302465710 | ||||||||
| FaxNumber: | 5302417838 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 92ND ST | ||||||||
| Address2: | 2B | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112096352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158233093 | ||||||||
| FaxNumber: | 4158233093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DDS50271 | CA | Y | Dental Providers | Dentist |
No ID Information.