Jackson, Brandon Joshua

Jackson, Brandon Joshua is an individual health care provider with primary practice located at 70 Virginia Ave , Staten Island NY 10305-1748. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is his primary health care specialty. Jackson, Brandon Joshua can be contacted via phone (718) 226-8851.

Contact Information

Primary practice address
70 Virginia Ave Staten Island NY 10305-1748
Phone: (718) 226-8851
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X New York
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Dental Providers / Pediatric Dentistry 1223P0221X 056966-1 New York

Profile Details

NPI number 1861753949
LBN Legal business name Jackson, Brandon Joshua
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2012
Last updated Sep 15th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861753949 NPPES
New York MEDICAID 390200000X

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