Provider Demographics
NPI:1194924993
Name:DEMBRO, JAY LEONARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:LEONARD
Last Name:DEMBRO
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:P.O.BOX 1318
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-1318
Mailing Address - Country:US
Mailing Address - Phone:508-563-9596
Mailing Address - Fax:
Practice Address - Street 1:85 HARBOR DR
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-1318
Practice Address - Country:US
Practice Address - Phone:508-563-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA135741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice