Provider Demographics
NPI:1376824946
Name:KAPLAN, JAY (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:KAPLAN
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 1:2209 SOUTH AVE
Mailing Address - Street 2:STE C
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7037
Mailing Address - Country:US
Mailing Address - Phone:530-542-4604
Mailing Address - Fax:530-542-9073
Practice Address - Street 1:2209 SOUTH AVE
Practice Address - Street 2:STE C
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7037
Practice Address - Country:US
Practice Address - Phone:530-542-4604
Practice Address - Fax:530-542-9073
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS 289421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics