Provider Demographics
NPI:1346340692
Name:KNUDSEN, JAY MORGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MORGAN
Last Name:KNUDSEN
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 1:460 MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083
Mailing Address - Country:US
Mailing Address - Phone:207-324-6182
Mailing Address - Fax:207-324-4336
Practice Address - Street 1:460 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083
Practice Address - Country:US
Practice Address - Phone:207-324-6182
Practice Address - Fax:207-324-4336
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice