Provider Demographics
NPI:1245750017
Name:JAIN, ANKIT A (DDS)
Entity Type:Individual
Prefix:
First Name:ANKIT
Middle Name:A
Last Name:JAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1050
Mailing Address - Country:US
Mailing Address - Phone:323-275-8236
Mailing Address - Fax:
Practice Address - Street 1:103 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1050
Practice Address - Country:US
Practice Address - Phone:323-275-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist