Provider Demographics
NPI:1740364066
Name:BUKZIN, JAY MEYER (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:MEYER
Last Name:BUKZIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7915 LAKE MANASSAS DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155
Mailing Address - Country:US
Mailing Address - Phone:703-753-7933
Mailing Address - Fax:703-743-9089
Practice Address - Street 1:7915 LAKE MANASSAS DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:703-753-7933
Practice Address - Fax:703-743-9089
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEG100011191223S0112X
NJ22DI022470001223S0112X
VA04014112561223S0112X
PADS0356951223S0112X
KY84161223S0112X
VA04380002121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008449880002Medicaid
PA1008449880002Medicaid
U97546Medicare UPIN