Provider Demographics
NPI:1942420450
Name:CASE, JAY CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:CHARLES
Last Name:CASE
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:PO BOX 828
Mailing Address - Street 2:115 N.E. OLDTOWN DRIVE
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-0828
Mailing Address - Country:US
Mailing Address - Phone:405-247-2458
Mailing Address - Fax:405-247-6653
Practice Address - Street 1:115 N.E. OLDTOWN DRIVE
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-0828
Practice Address - Country:US
Practice Address - Phone:405-247-2458
Practice Address - Fax:405-247-6653
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice