Provider Demographics
NPI:1790110005
Name:JAY ORTHODONTICS, P.C.
Entity Type:Organization
Organization Name:JAY ORTHODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:734-241-3399
Mailing Address - Street 1:314 N MONROE ST
Mailing Address - Street 2:JAY ORTHODONTICS, P.C
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2622
Mailing Address - Country:US
Mailing Address - Phone:734-241-3399
Mailing Address - Fax:734-241-4307
Practice Address - Street 1:314 N MONROE ST
Practice Address - Street 2:314 N MONROE STREET
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2622
Practice Address - Country:US
Practice Address - Phone:734-241-3399
Practice Address - Fax:734-241-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20147261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental