Provider Demographics
NPI:1891857074
Name:ABBOTT, JEREMY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JAMES
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 EXECUTIVE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3827
Mailing Address - Country:US
Mailing Address - Phone:301-530-8570
Mailing Address - Fax:
Practice Address - Street 1:6010 EXECUTIVE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3827
Practice Address - Country:US
Practice Address - Phone:301-530-8570
Practice Address - Fax:301-530-8572
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD158841223X2210X
MD158841223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist