| NPI | 1689780736 |
|---|---|
| Other Name | JAY VANDEWATER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 015342) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019020310) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2016-02-23 |