Provider Demographics
NPI:1790906659
Name:ELDER, JAY TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:TODD
Last Name:ELDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3601 COUNTY ROAD 1020
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-3498
Mailing Address - Country:US
Mailing Address - Phone:512-556-2547
Mailing Address - Fax:512-556-2537
Practice Address - Street 1:2402 WALKER PLACE BLVD
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3995
Practice Address - Country:US
Practice Address - Phone:254-547-6453
Practice Address - Fax:254-547-7401
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX159081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice