Provider Demographics
NPI:1629709068
Name:WAYNTRAUB, JAY (DDS)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:WAYNTRAUB
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 1:25540 KAREN ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1377
Mailing Address - Country:US
Mailing Address - Phone:248-905-1589
Mailing Address - Fax:
Practice Address - Street 1:7459 MIDDLEBELT RD STE 1
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4184
Practice Address - Country:US
Practice Address - Phone:248-737-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist