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General NPI Number Information
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NPI Number | 1699384834
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Entity Type | Individual
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Provider Name | JAYASHREE RAJESH THORAT DDS
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 6416 CARLISLE PIKE STE 500
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City | MECHANICSBURG
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State | PA
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Zip | 17050-2884
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Country | US
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Telephone | 717-766-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 VILLA WAY APT 356
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City | MINNEAPOLIS
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State | MN
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Zip | 55436-2150
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Country | US
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Telephone | 330-313-9332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DS042822
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License Number State | PA
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