Healthcare Provider Details

I. General information

NPI: 1013072115
Provider Name (Legal Business Name): JYOTI DESHMANE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/07/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 BRIDGE ROAD
SKIPPACK PA
19474-0137
US

IV. Provider business mailing address

9 CAMELOT WAY
HARLEYSVILLE PA
19438-2910
US

V. Phone/Fax

Practice location:
  • Phone: 610-222-8189
  • Fax: 610-222-8121
Mailing address:
  • Phone: 215-368-3813
  • Fax: 610-222-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS028689L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS-028689L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1926
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier784857
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUCCI PROV. ID
# 3
Identifier000000262309
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: