Provider Demographics
NPI:1538278486
Name:CHASON, JAY I (DDS)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:I
Last Name:CHASON
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 1:15 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5000
Mailing Address - Country:US
Mailing Address - Phone:410-857-2802
Mailing Address - Fax:410-857-2803
Practice Address - Street 1:15 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5000
Practice Address - Country:US
Practice Address - Phone:410-857-2802
Practice Address - Fax:410-857-2803
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV502Medicare ID - Type Unspecified
MDU36060Medicare UPIN