Provider Demographics
NPI:1326037797
Name:SMITH, JAY CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:CHRISTOPHER
Last Name:SMITH
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 1:7801 MIDDAY LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2722
Mailing Address - Country:US
Mailing Address - Phone:703-768-5310
Mailing Address - Fax:
Practice Address - Street 1:238 BROOKLEY AVE
Practice Address - Street 2:STE 214
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20332-0001
Practice Address - Country:US
Practice Address - Phone:202-404-3575
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029715L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist