Provider Demographics
NPI:1699773770
Name:WYLAM, JAY M (DMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:WYLAM
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 1:2605 12TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2576
Mailing Address - Country:US
Mailing Address - Phone:503-585-4281
Mailing Address - Fax:503-585-7427
Practice Address - Street 1:2605 12TH PL SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2576
Practice Address - Country:US
Practice Address - Phone:503-585-4281
Practice Address - Fax:503-585-7427
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR66371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics