Provider Demographics
NPI:1356449516
Name:GHOSH, JAY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:GHOSH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:JOYDEEP
Other - Middle Name:
Other - Last Name:GHOSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1780 W MCDERMOTT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3361
Mailing Address - Country:US
Mailing Address - Phone:214-547-0001
Mailing Address - Fax:214-547-1500
Practice Address - Street 1:1780 W MCDERMOTT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3361
Practice Address - Country:US
Practice Address - Phone:214-547-0001
Practice Address - Fax:214-547-1500
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics