Provider Demographics
NPI:1114086816
Name:JAY F. HAUSER, DDS, PC
Entity Type:Organization
Organization Name:JAY F. HAUSER, DDS, PC
Other - Org Name:PREMIER DENTAL PARTNERS CENTRAL WEST END
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:22 N EUCLID AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1407
Mailing Address - Country:US
Mailing Address - Phone:314-367-7702
Mailing Address - Fax:314-367-7726
Practice Address - Street 1:22 N EUCLID AVE STE 220
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1407
Practice Address - Country:US
Practice Address - Phone:314-367-7702
Practice Address - Fax:314-367-7726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY F. HAUSER, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID #