Individual
DR. JEREMY DAVID WANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
75 STEAMBOAT WHARF, APT 35, MYSTIC, CT 06355-2546
(724) 787-1661
Mailing address
1 WAHOO DRIVE, NAVAL BRANCH HEALTH CLINIC, GROTON, CT 06349
(860) 649-3129
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8774121-9921
UT
Other
Enumeration date
01/17/2014
Last updated
01/17/2014
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