Provider Demographics
NPI:1760731855
Name:KAY, JEREMY DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DAVID
Last Name:KAY
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 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 704
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:561-445-4998
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST STE 704
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2904
Practice Address - Country:US
Practice Address - Phone:561-445-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056846-1122300000X
FLDN 199141223G0001X
PADS0410611223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice