Provider Demographics
NPI:1487665030
Name:THAKKAR, JAGRUTI AJAY (DDS)
Entity Type:Individual
Prefix:
First Name:JAGRUTI
Middle Name:AJAY
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10346 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1102
Mailing Address - Country:US
Mailing Address - Phone:951-359-7500
Mailing Address - Fax:951-359-1650
Practice Address - Street 1:10346 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1102
Practice Address - Country:US
Practice Address - Phone:951-359-7500
Practice Address - Fax:951-359-1650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice