Provider Demographics
NPI:1629395264
Name:ALBANESE, JAY (DDS, MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:ALBANESE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD FORGE LN STE 301
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1932
Mailing Address - Country:US
Mailing Address - Phone:484-926-6001
Mailing Address - Fax:484-926-6002
Practice Address - Street 1:300 OLD FORGE LN STE 301
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1897
Practice Address - Country:US
Practice Address - Phone:484-926-6001
Practice Address - Fax:484-926-6002
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457711208600000X
PADS0394391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery