Healthcare Provider Details

I. General information

NPI: 1881887362
Provider Name (Legal Business Name): JAYGANESH MANOJ BHATT D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 E QUEEN CREEK RD STE 101
GILBERT AZ
85297-8501
US

IV. Provider business mailing address

3341 E QUEEN CREEK RD STE 101
GILBERT AZ
85297-8501
US

V. Phone/Fax

Practice location:
  • Phone: 480-305-3200
  • Fax:
Mailing address:
  • Phone: 480-305-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberBB9405689
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: