Provider Demographics
NPI:1881757110
Name:PONTIOUS, JAY RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:RICHARD
Last Name:PONTIOUS
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 1:123 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-722-0003
Mailing Address - Fax:828-333-5460
Practice Address - Street 1:123 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2868
Practice Address - Country:US
Practice Address - Phone:828-722-0003
Practice Address - Fax:828-333-5460
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
33082OtherDELTA DENTAL
MO2001033082OtherMO DENTAL REGISTRATION #
AP1037705OtherCONTROLLED SUBSTANCES REG