MEDICARE: JENNIFER WILEY 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	15244	MD

General Provider Information

NPI Number	:	1437593985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WILEY DDS

Provider Business Mailing Address
First Line	:	2507 N POINT RD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-1605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2507 N POINT RD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-1605
Country	:	US
Telephone Number	:	410-284-6650
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/25/2013

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