MEDICARE: DR. JAY CHRISTOPHER PLATT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12008814A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000084417	OTHER	IN	BC BS PROVIDER PIN NUMBER
2	000000084416	OTHER	IN	BC BS PROVIDER PIN NUMBER
3	761022	OTHER	IN	UNITED CONCORDIA NUMBER

General Provider Information

NPI Number	:	1518948041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY CHRISTOPHER PLATT D.D.S.

Provider Business Mailing Address
First Line	:	322 INDIANAPOLIS BOULEVARD
Second Line	:	SUITE 100
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2656
Country	:	US
Telephone Number	:	219-864-1133
Fax Number	:	219-864-9203

Provider Business Practice Location Address
First Line	:	322 INDIANAPOLIS BOULEVARD
Second Line	:	SUITE 100
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2656
Country	:	US
Telephone Number	:	219-864-1133
Fax Number	:	219-864-9203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. JAY CHRISTOPHER PLATT D.D.S.” Practice Location

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