Provider Demographics
NPI:1316229610
Name:MARRIAGE, JAY D (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:D
Last Name:MARRIAGE
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 1:1700 COUNTY ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423
Mailing Address - Country:US
Mailing Address - Phone:775-782-4525
Mailing Address - Fax:775-782-2134
Practice Address - Street 1:1700 COUNTY ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423
Practice Address - Country:US
Practice Address - Phone:775-782-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice