MEDICARE: JAY SMITH

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	DS25901	PA

General Provider Information

NPI Number	:	1881874139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY SMITH

Provider Business Mailing Address
First Line	:	314 POWHATTAN AVE
Second Line	:
City	:	ESSINGTON
State	:	PA
Zip	:	19029-1311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 POWHATTAN AVE
Second Line	:
City	:	ESSINGTON
State	:	PA
Zip	:	19029-1311
Country	:	US
Telephone Number	:	610-521-3313
Fax Number	:

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

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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Directions to “ JAY SMITH ” Practice Location

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