Healthcare Provider Details

I. General information

NPI: 1518948041
Provider Name (Legal Business Name): JAY CHRISTOPHER PLATT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 INDIANAPOLIS BOULEVARD SUITE 100
SCHERERVILLE IN
46375-2656
US

IV. Provider business mailing address

322 INDIANAPOLIS BOULEVARD SUITE 100
SCHERERVILLE IN
46375-2656
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-1133
  • Fax: 219-864-9203
Mailing address:
  • Phone: 219-864-1133
  • Fax: 219-864-9203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12008814A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: