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General NPI Number Information
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NPI Number | 1992217400
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Entity Type | Organization
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Legal Business Name | JAY S. DESVAUX, D.D.S.
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 6311 KINGSTON PIKE #27W
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City | KNOXVILLE
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State | TN
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Zip | 37919
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Country | US
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Telephone | 865-588-7862
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Fax | 865-558-6849
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Provider Business Mailing Address
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Address Line | 6311 KINGSTON PIKE #27W
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City | KNOXVILLE
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State | TN
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Zip | 37919
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Country | US
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Telephone | 865-588-7862
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Fax | 865-558-6849
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Authorized Official
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Title or Position | OWNER/DDS
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Name | DR. JAY S. DESVAUX
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Credential | D.D.S.
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Telephone | 865-588-7862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS3356
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License Number State | TN
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