Provider Demographics
NPI:1629224779
Name:WAITE, JAY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:J
Last Name:WAITE
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 1:7109 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1404
Mailing Address - Country:US
Mailing Address - Phone:520-319-1390
Mailing Address - Fax:520-881-5133
Practice Address - Street 1:7117 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1404
Practice Address - Country:US
Practice Address - Phone:520-722-1212
Practice Address - Fax:520-722-0336
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD2310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist