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General NPI Number Information
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NPI Number | 1790110005
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Entity Type | Organization
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Legal Business Name | JAY ORTHODONTICS, P.C.
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 314 N MONROE ST 314 N MONROE STREET
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City | MONROE
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State | MI
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Zip | 48162-2622
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Country | US
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Telephone | 734-241-3399
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Fax | 734-241-4307
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Provider Business Mailing Address
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Address Line | 314 N MONROE ST JAY ORTHODONTICS, P.C
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City | MONROE
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State | MI
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Zip | 48162-2622
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Country | US
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Telephone | 734-241-3399
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Fax | 734-241-4307
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN DAVID JAY
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Credential | D.D.S., M.S.D.
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Telephone | 734-241-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 20147
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License Number State | MI
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