Provider Demographics
NPI:1417014994
Name:AFROW, JAY R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:R
Last Name:AFROW
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:WENTWORTH-DOUGLASS COMMUNITY DENTAL CTR
Mailing Address - Street 2:668 CENTRAL AVE
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820
Mailing Address - Country:US
Mailing Address - Phone:603-749-3013
Mailing Address - Fax:603-749-2915
Practice Address - Street 1:WENTWORTH-DOUGLASS COMMUNITY DENTAL CTR
Practice Address - Street 2:668 CENTRAL AVE
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-749-3013
Practice Address - Fax:603-749-2915
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH35281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010542Medicaid
ME432245399Medicaid