Provider Demographics
NPI:1649264466
Name:NOKKEO, JAY SAHARAT (DMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:SAHARAT
Last Name:NOKKEO
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Gender:M
Credentials:DMD
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Mailing Address - Street 1:507 N FREDERICK AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2506
Mailing Address - Country:US
Mailing Address - Phone:301-926-4800
Mailing Address - Fax:301-926-4899
Practice Address - Street 1:507 N FREDERICK AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2506
Practice Address - Country:US
Practice Address - Phone:301-926-4800
Practice Address - Fax:301-926-4899
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD132711223S0112X, 204E00000X
DCDEN60061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery