Provider Demographics
NPI:1437161551
Name:GHATNEKAR, JEEVAN VINAYAK (DDS)
Entity Type:Individual
Prefix:MR
First Name:JEEVAN
Middle Name:VINAYAK
Last Name:GHATNEKAR
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 1:2 OSBORN ST. #130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-552-1380
Mailing Address - Fax:949-552-5980
Practice Address - Street 1:2 OSBORN ST STE 130
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8656
Practice Address - Country:US
Practice Address - Phone:949-552-1380
Practice Address - Fax:949-552-5980
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB33425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist