MEDICARE: DR. AJAY KESHAVLAL DAVE DDS

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	DS3857	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992860613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJAY KESHAVLAL DAVE DDS

Provider Business Mailing Address
First Line	:	3216 PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-3046
Country	:	US
Telephone Number	:	901-327-0003
Fax Number	:	901-327-1894

Provider Business Practice Location Address
First Line	:	3216 PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-3046
Country	:	US
Telephone Number	:	901-327-0003
Fax Number	:	901-327-1894

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/30/2007

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