Healthcare Provider Details

I. General information

NPI: 1851554943
Provider Name (Legal Business Name): JEREMY M JEWELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22808 ROUTE 68
CLARION PA
16214-8512
US

IV. Provider business mailing address

22808 ROUTE 68
CLARION PA
16214-8512
US

V. Phone/Fax

Practice location:
  • Phone: 814-223-9968
  • Fax: 814-223-9967
Mailing address:
  • Phone: 814-223-9968
  • Fax: 814-223-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037503
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: