Provider Demographics
NPI:1033748066
Name:DEZWIREK, JEREMIE (DDS)
Entity Type:Individual
Prefix:
First Name:JEREMIE
Middle Name:
Last Name:DEZWIREK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 SCHUCK ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4120
Mailing Address - Country:US
Mailing Address - Phone:408-497-7739
Mailing Address - Fax:
Practice Address - Street 1:8114 SANDPIPER CIR STE 210
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5902
Practice Address - Country:US
Practice Address - Phone:410-931-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD176431223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice