MEDICARE: DR. JAY HEYDEN SCIUCHETTI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7642	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7642	OTHER	WA	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760464432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY HEYDEN SCIUCHETTI DDS

Provider Business Mailing Address
First Line	:	2103 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2349
Country	:	US
Telephone Number	:	509-624-0542
Fax Number	:	509-624-2332

Provider Business Practice Location Address
First Line	:	2103 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2349
Country	:	US
Telephone Number	:	509-624-0542
Fax Number	:	509-624-2332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	06/05/2023

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