Provider Demographics
NPI:1548286131
Name:KAYTON, JACK T III (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:T
Last Name:KAYTON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 OLD IVY WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4894
Mailing Address - Country:US
Mailing Address - Phone:434-977-3939
Mailing Address - Fax:434-984-1728
Practice Address - Street 1:315 OLD IVY WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4894
Practice Address - Country:US
Practice Address - Phone:434-977-3939
Practice Address - Fax:434-984-1728
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice