Provider Demographics
NPI:1720414790
Name:BURTON, JAY BAKER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:BAKER
Last Name:BURTON
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 1:711 E MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2741
Mailing Address - Country:US
Mailing Address - Phone:731-334-7183
Mailing Address - Fax:
Practice Address - Street 1:278 1ST AVE APT 7D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-1829
Practice Address - Country:US
Practice Address - Phone:731-334-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-22
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9276122300000X
TN98691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist