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General NPI Number Information
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NPI Number | 1619160199
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Entity Type | Organization
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Legal Business Name | SERENITY DENTAL
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 3341 E QUEEN CREEK RD STE 101
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City | GILBERT
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State | AZ
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Zip | 85297-8501
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Country | US
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Telephone | 480-305-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 3341 E QUEEN CREEK RD
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City | GILBERT
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State | AZ
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Zip | 85297-8501
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Country | US
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Telephone | 480-305-3200
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JAYGANESH MANOJ BHATT
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Credential | D.D.S
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Telephone | 480-305-3200
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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 | BB9405689
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License Number State | AZ
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