Provider Demographics
NPI:1912917733
Name:WOOSTER, JAY SCOTT (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:SCOTT
Last Name:WOOSTER
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 1:591 BROWNS COVE RD STE A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-7281
Mailing Address - Country:US
Mailing Address - Phone:843-645-7844
Mailing Address - Fax:843-645-7846
Practice Address - Street 1:591 BROWNS COVE RD
Practice Address - Street 2:UNIT A
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7280
Practice Address - Country:US
Practice Address - Phone:843-645-7844
Practice Address - Fax:843-645-7846
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC03360122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1912917733OtherSOUTH CAROLINA