Provider Demographics
NPI:1639305345
Name:CLAYWELL, JAY RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:RYAN
Last Name:CLAYWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1750
Mailing Address - Country:US
Mailing Address - Phone:502-348-5901
Mailing Address - Fax:502-348-7260
Practice Address - Street 1:621 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1750
Practice Address - Country:US
Practice Address - Phone:502-348-5901
Practice Address - Fax:502-348-7260
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY87271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice