Provider Demographics
NPI:1346277985
Name:HOLTHUS, JAY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:HOLTHUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:190 MEIXELL CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9258
Mailing Address - Country:US
Mailing Address - Phone:570-522-0162
Mailing Address - Fax:
Practice Address - Street 1:210 JPM RD
Practice Address - Street 2:SUITE 302
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9367
Practice Address - Country:US
Practice Address - Phone:570-522-7070
Practice Address - Fax:570-522-7072
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0351131223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry