Individual
JAY ANJANKUMAR MISTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
204 N CEDAR ST, NEVADA, MO 64772-2310
(844) 853-8937
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 885-8131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2020015672
MO
1223G0001X
General Practice Dentistry
30.025824
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30.025824
STATE LICENSE
OH
Enumeration date
06/12/2019
Last updated
11/27/2023
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