MEDICARE: VIKAS RAJA JAIN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8503	SC

General Provider Information

NPI Number	:	1578983565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKAS RAJA JAIN DMD

Provider Business Mailing Address
First Line	:	807 S PENDLETON ST
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3527
Country	:	US
Telephone Number	:	864-855-6563
Fax Number	:	864-855-6530

Provider Business Practice Location Address
First Line	:	807 S PENDLETON ST
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3527
Country	:	US
Telephone Number	:	864-855-6563
Fax Number	:	864-855-6530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	08/06/2015

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Directions to “ VIKAS RAJA JAIN DMD” Practice Location

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