Provider Demographics
NPI:1134133341
Name:WEST, JAY B (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:B
Last Name:WEST
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 1:1050 LARPENTEUR AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6556
Mailing Address - Country:US
Mailing Address - Phone:651-488-5522
Mailing Address - Fax:651-488-0944
Practice Address - Street 1:1050 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6556
Practice Address - Country:US
Practice Address - Phone:651-488-5522
Practice Address - Fax:651-488-0944
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7B149STOtherBCBS