Provider Demographics
NPI:1831416395
Name:DEDEKER, JAY ALAN (MSS)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:ALAN
Last Name:DEDEKER
Suffix:
Gender:M
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6711 MOUNTAIN VIEW RD STE 115
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6667
Mailing Address - Country:US
Mailing Address - Phone:423-238-1127
Mailing Address - Fax:423-238-1277
Practice Address - Street 1:6711 MOUNTAIN VIEW RD STE 115
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6667
Practice Address - Country:US
Practice Address - Phone:423-238-1127
Practice Address - Fax:423-238-1277
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist