Healthcare Provider Details

I. General information

NPI: 1548465339
Provider Name (Legal Business Name): JAY PLATT DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/22/2007
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: DR. JAY C PLATT
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 219-864-1133