DR. LISA ANN JEDACEK DMD, MPH - NPI 1528650710

Q: What is the provider's specialty?

The provider's specialty is Dentist with taxonomy code 1223D0004X and a focus in Dentist Anesthesiologist.

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About Dr. Lisa Ann Jedacek Dmd, Mph NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. LISA ANN JEDACEK DMD, MPH (NPI 1528650710) is an individual dentist anesthesiologist in Bronx, New York, licensed in Virginia (0401418721) and active in the NPI registry since February 2021. She maintains 8 additional practice locations.

NPPES Registry Identity

NPI1528650710

Entity TypeIndividualFemale

Primary Taxonomy1223D0004X

Provider Legal NameDR. LISA ANN JEDACEKCredential: DMD, MPH

Location Address1400 PELHAM PKWY SBronx, NY 10461-1197

Mailing Address1817 Mayflower AveBronx, NY 10461-4103 · (440) 665-3973

Phone(718) 918-5000

Sole ProprietorNo

Enumeration DateFebruary 9, 2021

Last NPPES UpdateJuly 9, 20243 updates tracked since enumeration

NPPES CertifiedJuly 9, 2024

✔ NPI 1528650710 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Dentist AnesthesiologistDental Providers

Taxonomy Code1223D0004X

Licenses✔ Licensed in VA · 0401418721✔ Licensed in MA · DN10000315✔ Licensed in MI · 2901602093✔ Licensed in OH · 30.027607

Definition

A dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation's Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology.

Also ListedDentistTaxonomy 122300000X · License 22DI03015700 (NJ), 0401418721 (VA), DN10000315 (MA), 2901602093 (MI), 30.027607 (OH)

1400 PELHAM PKWY S, Bronx, NY 10461

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Secondary Practice Locations 8

Location 11516 NJ-138, Suite #1aWall Township, NJ 07719 · Phone (732) 681-5544

Location 21700 Monroe StEndicott, NY 13760-5512 · Phone (607) 953-4445

Location 3378 Atlantic AveBrooklyn, NY 11217-5000 · Phone (718) 412-5221

Location 45002 Airport Rd NW # 30Roanoke, VA 24012-1607 · Phone (540) 900-4782

Location 51817 Mayflower AveBronx, NY 10461-4103 · Phone (440) 665-3973

Location 611934 W Broad St Ste 120Henrico, VA 23233-1100 · Phone (804) 293-2662

Location 72165 Cunningham DrHampton, VA 23666-2569 · Phone (757) 755-8846

Location 84749 S Baldwin RdLake Orion, MI 48359-2114 · Phone (248) 422-0555

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Delta Dental of Ohio.Insurance ›

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. DANIELA IACOBONI MS, CGC

Genetic Counselor, MS

1400 PELHAM PKWY S, BUILDING 1, ROOM 1N43H
BRONX, NY 10461

Bronx County (917) 738-3861

DR. STEPHEN DAVID APFELROTH M.D., PH.D.

General Practice

1400 PELHAM PKWY S, JACOBI MEDICAL CENTER 1E12
BRONX, NY 10461

Bronx County (718) 918-5233

DR. CHRISTINE HENG D.D.S.

Dentist

1400 PELHAM PKWY S, JACOBI MEDICAL CENTER
BRONX, NY 10461

Bronx County (718) 918-3419

DIAHANN L SEAMAN M.D.

Internal Medicine (Gastroenterology)