Provider Demographics
NPI:1518625656
Name:WOLSEY, JAY ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ANDREW
Last Name:WOLSEY
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 1:453 S BURR OAK LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4851
Mailing Address - Country:US
Mailing Address - Phone:801-362-8989
Mailing Address - Fax:
Practice Address - Street 1:110 S 100 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2102
Practice Address - Country:US
Practice Address - Phone:801-465-4855
Practice Address - Fax:801-465-9562
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT124481941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice