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General NPI Number Information
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NPI Number | 1063856128
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Entity Type | Organization
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Legal Business Name | JAYATI C. BHATTACHARYYA DDS PC
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 702 N BEERS ST STE 3
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City | HOLMDEL
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State | NJ
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Zip | 07733-1510
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Country | US
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Telephone | 732-739-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 702 N BEERS ST STE 3
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City | HOLMDEL
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State | NJ
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Zip | 07733-1510
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Country | US
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Telephone | 732-739-3535
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. JAYATI C. BHATTACHARYYA
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Credential | DDS
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Telephone | 732-739-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22D102331201
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License Number State | NJ
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