Provider Demographics
NPI:1053727727
Name:ACZON, JEREMY (DMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:ACZON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SEWALL AVENUE
Mailing Address - Street 2:APT 2F
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5315
Mailing Address - Country:US
Mailing Address - Phone:856-498-8998
Mailing Address - Fax:
Practice Address - Street 1:319 LYNNWAY
Practice Address - Street 2:LYNN CHILDREN DENTISTRY
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901
Practice Address - Country:US
Practice Address - Phone:781-475-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist