MEDICARE: JAY PLATT DDS PC

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

General Provider Information

NPI Number	:	1548465339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY PLATT DDS PC

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	:	PRESIDENT
Name	:	DR. JAY C PLATT
Credential	:	D.D.S.
Telephone Number	:	219-864-1133

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	08/22/2007

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