Provider Demographics
NPI:1598841173
Name:AHUJA, JAY (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:AHUJA
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 1:1425 BRISTOL PLACE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-0926
Mailing Address - Country:US
Mailing Address - Phone:704-542-7698
Mailing Address - Fax:
Practice Address - Street 1:3901 ROSEHAVEN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5918
Practice Address - Country:US
Practice Address - Phone:704-536-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice