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General NPI Number Information
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NPI Number | 1578229464
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Entity Type | Individual
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Provider Name | JEREMY WAY DDS
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Gender | Male
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 5410 LYNX LN STE 290
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City | COLUMBIA
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State | MD
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Zip | 21044-2483
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Country | US
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Telephone | 410-910-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 2 HOPKINS PLZ UNIT 1318
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City | BALTIMORE
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State | MD
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Zip | 21201-2940
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Country | US
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Telephone | 301-520-6148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17705
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License Number State | MD
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