Provider Demographics
NPI:1083086466
Name:JAY F. HAUSER, DDS, PC
Entity Type:Organization
Organization Name:JAY F. HAUSER, DDS, PC
Other - Org Name:PREMIER DENTAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-367-1243
Mailing Address - Street 1:22 N EUCLID AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1407
Mailing Address - Country:US
Mailing Address - Phone:314-367-1243
Mailing Address - Fax:
Practice Address - Street 1:750 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7726
Practice Address - Country:US
Practice Address - Phone:314-367-1243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY F. HAUSER, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty