Provider Demographics
NPI:1497285407
Name:CHAY, JONATHAN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:CHAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:W
Other - Last Name:CHAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:410A PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3502
Mailing Address - Country:US
Mailing Address - Phone:864-232-3333
Mailing Address - Fax:
Practice Address - Street 1:410A PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3502
Practice Address - Country:US
Practice Address - Phone:864-232-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
SC100691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX0045Medicaid