Provider Demographics
NPI:1881602837
Name:WARDIUS, JAY BRYAN (DMD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:BRYAN
Last Name:WARDIUS
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 1:3129 NAAMANS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-2521
Mailing Address - Country:US
Mailing Address - Phone:610-494-3166
Mailing Address - Fax:610-494-2840
Practice Address - Street 1:3129 NAAMANS CREEK RD
Practice Address - Street 2:
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061-2521
Practice Address - Country:US
Practice Address - Phone:610-494-3166
Practice Address - Fax:610-494-2840
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027827-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice