Provider Demographics
NPI:1336279918
Name:DE POL, JAY BERNARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:BERNARD
Last Name:DE POL
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 1:1298 BAY DALE DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-757-9222
Mailing Address - Fax:410-757-0714
Practice Address - Street 1:1298 BAY DALE DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012
Practice Address - Country:US
Practice Address - Phone:410-757-9222
Practice Address - Fax:410-757-0714
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist