Provider Demographics
NPI:1467863332
Name:JAYJOHN, ERICK (DDS)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:JAYJOHN
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 1:190 WATER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1384
Mailing Address - Country:US
Mailing Address - Phone:740-286-0480
Mailing Address - Fax:740-286-8968
Practice Address - Street 1:190 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1384
Practice Address - Country:US
Practice Address - Phone:740-286-0480
Practice Address - Fax:740-286-8968
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist