Provider Demographics
NPI:1326181306
Name:JAY F. HAUSER, DDS, PC
Entity Type:Organization
Organization Name:JAY F. HAUSER, DDS, PC
Other - Org Name:PREMIER DENTAL PARTNERS WEST COUNTY - OLIVE BLVD
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 1:12528 OLIVE BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-878-0122
Mailing Address - Fax:314-878-0132
Practice Address - Street 1:12528 OLIVE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-878-0122
Practice Address - Fax:314-878-0132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY F. HAUSER, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID