MEDICARE: DR. JAYLON LEAVITT WAITE DDS

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	1223G0001X	General Practice Dentistry	D-4097	ID

General Provider Information

NPI Number	:	1558555946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYLON LEAVITT WAITE DDS

Provider Business Mailing Address
First Line	:	UNITED STATES MILITARY ACADEMY
Second Line	:	646 SWIFT ROAD, BLDG 606
City	:	WEST POINT
State	:	NY
Zip	:	10996-1942
Country	:	US
Telephone Number	:	845-938-7759
Fax Number	:	845-938-4302

Provider Business Practice Location Address
First Line	:	UNITED STATES MILITARY ACADEMY
Second Line	:	646 SWIFT ROAD, BLDG 606
City	:	WEST POINT
State	:	NY
Zip	:	10996-1942
Country	:	US
Telephone Number	:	845-938-7759
Fax Number	:	845-938-4302

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	03/08/2023

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