Provider Demographics
NPI:1740549518
Name:VARGHESE, JAY GEORGE (DMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:GEORGE
Last Name:VARGHESE
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 1:63 WELLS AVE APT 1008
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2891
Mailing Address - Country:US
Mailing Address - Phone:917-593-5078
Mailing Address - Fax:
Practice Address - Street 1:475 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1240
Practice Address - Country:US
Practice Address - Phone:330-773-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0267231223G0001X
NY0570741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice