Provider Demographics
NPI:1316167406
Name:JAY D MARRIAGE DDS
Entity type:Organization
Organization Name:JAY D MARRIAGE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARRIAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-782-4525
Mailing Address - Street 1:1700 COUNTY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423
Mailing Address - Country:US
Mailing Address - Phone:775-782-4525
Mailing Address - Fax:775-782-2134
Practice Address - Street 1:1700 COUNTY RD
Practice Address - Street 2:SUITE B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423
Practice Address - Country:US
Practice Address - Phone:775-782-4525
Practice Address - Fax:775-782-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty