Provider Demographics
NPI:1760464432
Name:SCIUCHETTI, JAY HEYDEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:HEYDEN
Last Name:SCIUCHETTI
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 1:2103 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2349
Mailing Address - Country:US
Mailing Address - Phone:509-624-0542
Mailing Address - Fax:509-624-2332
Practice Address - Street 1:2103 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2349
Practice Address - Country:US
Practice Address - Phone:509-624-0542
Practice Address - Fax:509-624-2332
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA76421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7642OtherLICENSE NUMBER
WA5032867Medicaid