MEDICARE: GAYATRI JADHAV

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	1223G0001X	General Practice Dentistry	37746	TX

General Provider Information

NPI Number	:	1659047447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYATRI JADHAV

Provider Business Mailing Address
First Line	:	4315 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2017
Country	:	US
Telephone Number	:	201-399-3958
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2017
Country	:	US
Telephone Number	:	201-399-3958
Fax Number	:

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

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	08/20/2021

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Directions to “ GAYATRI JADHAV ” Practice Location

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