Provider Demographics
NPI:1073551693
Name:PRESTON, JAY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:DAVID
Last Name:PRESTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:721 N ROSE DR APT C314
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7534
Mailing Address - Country:US
Mailing Address - Phone:262-259-5792
Mailing Address - Fax:
Practice Address - Street 1:309 E 2ND ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1854
Practice Address - Country:US
Practice Address - Phone:909-623-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS104787122300000X
WI5002022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist