Provider Demographics
NPI:1346810892
Name:NAAS, JEREMIAH (LD, CDT)
Entity type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:
Last Name:NAAS
Suffix:
Gender:M
Credentials:LD, CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BRIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5114
Mailing Address - Country:US
Mailing Address - Phone:207-314-7873
Mailing Address - Fax:
Practice Address - Street 1:3 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5114
Practice Address - Country:US
Practice Address - Phone:207-314-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDTR5538122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist