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General NPI Number Information
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NPI Number | 1386860146
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Entity Type | Organization
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Legal Business Name | JAY I. BHATT DDS
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 1111 GRAND AVE SUITE G
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4171
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Country | US
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Telephone | 909-396-7474
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Fax | 909-860-4443
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Provider Business Mailing Address
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Address Line | 1111 GRAND AVE SUITE G
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4171
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Country | US
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Telephone | 909-396-7474
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Fax | 909-860-4443
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Authorized Official
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Title or Position | OWNER
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Name | JAY I. BHATT
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Credential | DDS
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Telephone | 909-861-2811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 33064
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License Number State | CA
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