Provider Demographics
NPI:1801244652
Name:JAY REDD DMD PC
Entity type:Organization
Organization Name:JAY REDD DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-688-1577
Mailing Address - Street 1:2301 SANTA CLARA DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5472
Mailing Address - Country:US
Mailing Address - Phone:435-688-1577
Mailing Address - Fax:
Practice Address - Street 1:2301 SANTA CLARA DR
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5472
Practice Address - Country:US
Practice Address - Phone:435-688-1577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty