Provider Demographics
NPI:1245451863
Name:SHARTZER, JAY C (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
Last Name:SHARTZER
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 1:11609 S CLEVELAND AVE STE 24
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2869
Mailing Address - Country:US
Mailing Address - Phone:239-275-8880
Mailing Address - Fax:239-275-7688
Practice Address - Street 1:11609 S CLEVELAND AVE STE 24
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2869
Practice Address - Country:US
Practice Address - Phone:239-275-8880
Practice Address - Fax:239-275-7688
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice