Provider Demographics
NPI:1063597573
Name:LAY, WAYNE D (DMD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:D
Last Name:LAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8907
Mailing Address - Country:US
Mailing Address - Phone:270-982-3811
Mailing Address - Fax:270-982-3811
Practice Address - Street 1:238 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1554
Practice Address - Country:US
Practice Address - Phone:270-765-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5775122300000X
FLDN10093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist