Provider Demographics
NPI:1669698064
Name:JEDWAB, GILA (DMD)
Entity type:Individual
Prefix:DR
First Name:GILA
Middle Name:
Last Name:JEDWAB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1128
Mailing Address - Country:US
Mailing Address - Phone:516-569-2957
Mailing Address - Fax:
Practice Address - Street 1:360 CENTRAL AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559
Practice Address - Country:US
Practice Address - Phone:516-295-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0498581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist