Healthcare Provider Details

I. General information

NPI: 1891857074
Provider Name (Legal Business Name): JEREMY JAMES ABBOTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 EXECUTIVE BLVD STE 500
ROCKVILLE MD
20852-3827
US

IV. Provider business mailing address

6010 EXECUTIVE BLVD STE 500
ROCKVILLE MD
20852-3827
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-8570
  • Fax: 301-530-8572
Mailing address:
  • Phone: 301-530-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberD15884
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15884
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number15884
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: