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General NPI Number Information
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NPI Number | 1942738026
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Entity Type | Individual
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Provider Name | ANDREW ANIL JATTAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 343 WARRIOR RD DENTAL CLINIC 3 BLDG 2115
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City | FORT STEWART
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State | GA
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Zip | 31314
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Country | US
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Telephone | 912-435-5546
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Fax |
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Provider Business Mailing Address
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Address Line | 124 KERRY DR
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City | RICHMOND HILL
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State | GA
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Zip | 31324-9210
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Country | US
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Telephone | 707-718-8062
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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 | DN22623
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License Number State | FL
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