Provider Demographics
NPI:1851554943
Name:JEWELL, JEREMY M (DMD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:M
Last Name:JEWELL
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 1:22808 ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8512
Mailing Address - Country:US
Mailing Address - Phone:814-223-9968
Mailing Address - Fax:814-223-9967
Practice Address - Street 1:22808 ROUTE 68
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8512
Practice Address - Country:US
Practice Address - Phone:814-223-9968
Practice Address - Fax:814-223-9967
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0375031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice