MEDICARE: DR. JON JAY WENDELL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	2493	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2493	OTHER	NH	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033273842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON JAY WENDELL D.D.S.

Provider Business Mailing Address
First Line	:	150 GRIFFIN RD STE 1
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-7131
Country	:	US
Telephone Number	:	603-436-2204
Fax Number	:	603-436-4158

Provider Business Practice Location Address
First Line	:	150 GRIFFIN RD STE 1
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-7131
Country	:	US
Telephone Number	:	603-436-2204
Fax Number	:	603-436-4158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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