Provider Demographics
NPI:1992217400
Name:JAY S. DESVAUX, D.D.S.
Entity Type:Organization
Organization Name:JAY S. DESVAUX, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DESVAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-588-7862
Mailing Address - Street 1:6311 KINGSTON PIKE #27W
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-588-7862
Mailing Address - Fax:865-558-6849
Practice Address - Street 1:6311 KINGSTON PIKE #27W
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-588-7862
Practice Address - Fax:865-558-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty