Provider Demographics
NPI:1558555946
Name:WAITE, JAYLON LEAVITT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYLON
Middle Name:LEAVITT
Last Name:WAITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:UNITED STATES MILITARY ACADEMY
Mailing Address - Street 2:646 SWIFT ROAD, BLDG 606
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1942
Mailing Address - Country:US
Mailing Address - Phone:845-938-7759
Mailing Address - Fax:845-938-4302
Practice Address - Street 1:UNITED STATES MILITARY ACADEMY
Practice Address - Street 2:646 SWIFT ROAD, BLDG 606
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1942
Practice Address - Country:US
Practice Address - Phone:845-938-7759
Practice Address - Fax:845-938-4302
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDD-40971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice