Provider Demographics
NPI:1225137110
Name:WONDER, JAY H (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:H
Last Name:WONDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2130
Mailing Address - Country:US
Mailing Address - Phone:610-376-3929
Mailing Address - Fax:610-376-8641
Practice Address - Street 1:1248 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2130
Practice Address - Country:US
Practice Address - Phone:610-376-3929
Practice Address - Fax:610-376-8641
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016570-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice