Provider Demographics
NPI:1063485654
Name:NESVOLD, JAY ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALLAN
Last Name:NESVOLD
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 1:278 LAFAYETTE ROAD
Mailing Address - Street 2:BLDG E
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5455
Mailing Address - Country:US
Mailing Address - Phone:603-430-9009
Mailing Address - Fax:
Practice Address - Street 1:278 LAFAYETTE ROAD
Practice Address - Street 2:BLDG E
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5455
Practice Address - Country:US
Practice Address - Phone:603-430-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214601223D0001X, 1223G0001X
NH32931223G0001X
MND115531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223D0001XDental ProvidersDentistDental Public Health
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30303822Medicaid
MA1201514Medicaid
NH30303822Medicaid
MAX20150Medicare ID - Type Unspecified