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Provider Information for 1386773166

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DR. BRENT CARL LAY DDS

Gender: MALE

Individual NPI: 1386773166

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1386773166
Enumeration Date 2007-03-05
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 24900 HIGHLAND WAY
LOS GATOS, CA 95033-8002
United States

Phone: 408-353-1191 | Fax: 408-353-6501
View Map External Link
Primary Practice Address 24900 HIGHLAND WAY
LOS GATOS, CA 95033-8002
United States

Phone: 408-353-1191 | Fax: 408-353-6501
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 34142
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location