Provider Demographics
NPI:1386860146
Name:JAY I. BHATT DDS
Entity Type:Organization
Organization Name:JAY I. BHATT DDS
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:I
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-861-2811
Mailing Address - Street 1:1111 GRAND AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4171
Mailing Address - Country:US
Mailing Address - Phone:909-396-7474
Mailing Address - Fax:909-860-4443
Practice Address - Street 1:1111 GRAND AVE
Practice Address - Street 2:SUITE G
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4171
Practice Address - Country:US
Practice Address - Phone:909-396-7474
Practice Address - Fax:909-860-4443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty