Individual
DR. JEREMY KEITH MASENIOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12165 ELM ST, PRINCESS ANNE, MD 21853-1358
(410) 651-5151
(410) 651-4256
Mailing address
PO BOX 1978, SALISBURY, MD 21802-1978
(410) 749-1015
(410) 749-0654
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DT2403
HI
1223G0001X
General Practice Dentistry
Primary
15315
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119591300
—
MD
Enumeration date
05/17/2010
Last updated
03/14/2016
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