MEDICARE: DR. JEREMY DAVID KAY D.M.D.

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	122300000X	Dentist	056846-1	NY
2	1223G0001X	General Practice Dentistry	DN 19914	FL
3	1223P0700X	Prosthodontics	DS041061	PA

General Provider Information

NPI Number	:	1760731855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY DAVID KAY D.M.D.

Provider Business Mailing Address
First Line	:	1601 WALNUT ST
Second Line	:	SUITE 704
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102
Country	:	US
Telephone Number	:	561-445-4998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST STE 704
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2904
Country	:	US
Telephone Number	:	561-445-4998
Fax Number	:

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

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	07/13/2017

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