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  7. NPI Record 1063485654

DR. JAY ALLAN NESVOLD DDS
Complete NPI Record 1063485654
Dentist - Dental Public Health in Portsmouth, NH

NPI Status: Active since February 13, 2006

Contact Information

278 LAFAYETTE ROAD
BLDG E
PORTSMOUTH, NH
ZIP 03801
Phone: (603) 430-9009

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Name Prefix Text
  7. Provider Credential Text
  8. Provider First Line Business Mailing Address
  9. Provider Second Line Business Mailing Address
  10. Provider Business Mailing Address City Name
  11. Provider Business Mailing Address State Name
  12. Provider Business Mailing Address Postal Code
  13. Provider Business Mailing Address Country Code If outside U S
  14. Provider Business Mailing Address Telephone Number
  15. Provider First Line Business Practice Location Address
  16. Provider Second Line Business Practice Location Address
  17. Provider Business Practice Location Address City Name
  18. Provider Business Practice Location Address State Name
  19. Provider Business Practice Location Address Postal Code
  20. Provider Business Practice Location Address Country Code If outside U S
  21. Provider Business Practice Location Address Telephone Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Provider Gender Code
  25. Healthcare Provider Taxonomy Code 1
  26. Provider License Number 1
  27. Provider License Number State Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Healthcare Provider Taxonomy Code 2
  30. Provider License Number 2
  31. Provider License Number State Code 2
  32. Healthcare Provider Primary Taxonomy Switch 2
  33. Healthcare Provider Taxonomy Code 3
  34. Provider License Number 3
  35. Provider License Number State Code 3
  36. Healthcare Provider Primary Taxonomy Switch 3
  37. Healthcare Provider Taxonomy Code 4
  38. Provider License Number 4
  39. Provider License Number State Code 4
  40. Healthcare Provider Primary Taxonomy Switch 4
  41. Other Provider Identifier 1
  42. Other Provider Identifier Type Code 1
  43. Other Provider Identifier State 1
  44. Other Provider Identifier 2
  45. Other Provider Identifier Type Code 2
  46. Other Provider Identifier State 2
  47. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1063485654. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1063485654
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: JAY
The first name of the provider, if the provider is an individual.
Provider Middle Name: ALLAN
The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: DR.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: DDS
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 278 LAFAYETTE ROAD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: BLDG E
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: PORTSMOUTH
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NH
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 038015455
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The city name in the location address of the provider being identified.
Provider Business Mailing Address Telephone Number: 6034309009
The State code in the location of the provider being identified.
Provider First Line Business Practice Location Address: 278 LAFAYETTE ROAD
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Second Line Business Practice Location Address: BLDG E
The country code in the location address of the provider being identified.
Provider Business Practice Location Address City Name: PORTSMOUTH
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address State Name: NH
The fax number associated with the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 038015455
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address Country Code If outside U S : US
The date that a record was last updated or changed.
Provider Business Practice Location Address Telephone Number: 6034309009
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 2/13/2006
The first name of the authorized official.
Last Update Date: 7/8/2007
The middle name of the authorized official.
Provider Gender Code: M
The title or position of the authorized official.
Healthcare Provider Taxonomy Code 1: 1223D0001X
The 10-position telephone number of the authorized official.
Provider License Number 1: 21460
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 1: MA
Healthcare Provider Primary Taxonomy Switch 1: X
Healthcare Provider Taxonomy Code 2: 1223G0001X
Provider License Number 2: D11553
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: MN
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: X
Healthcare Provider Taxonomy Code 3: 1223G0001X
Provider License Number 3: 3293
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: NH
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: X
Healthcare Provider Taxonomy Code 4: 1223G0001X
Provider License Number 4: 21460
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: MA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: X
Other Provider Identifier 1: 30303822
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: NH
Other Provider Identifier 2: 1201514
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: MA
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No