Provider Demographics
NPI:1346851672
Name:KUDEREWSKI, JAY SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:SCOTT
Last Name:KUDEREWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COOL SPRINGS BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6475
Mailing Address - Country:US
Mailing Address - Phone:615-771-1111
Mailing Address - Fax:615-771-5113
Practice Address - Street 1:5073 MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2738
Practice Address - Country:US
Practice Address - Phone:615-302-4200
Practice Address - Fax:615-302-4201
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist