Provider Demographics
NPI:1629162425
Name:KRUSKA, JAY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:LYNN
Last Name:KRUSKA
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-0779
Mailing Address - Country:US
Mailing Address - Phone:580-726-2524
Mailing Address - Fax:580-726-3425
Practice Address - Street 1:125 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651
Practice Address - Country:US
Practice Address - Phone:580-726-2524
Practice Address - Fax:580-726-3425
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice