Provider Demographics
NPI:1518948041
Name:PLATT, JAY CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:CHRISTOPHER
Last Name:PLATT
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 1:322 INDIANAPOLIS BOULEVARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2656
Mailing Address - Country:US
Mailing Address - Phone:219-864-1133
Mailing Address - Fax:219-864-9203
Practice Address - Street 1:322 INDIANAPOLIS BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2656
Practice Address - Country:US
Practice Address - Phone:219-864-1133
Practice Address - Fax:219-864-9203
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008814A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084417OtherBC BS PROVIDER PIN NUMBER
IN000000084416OtherBC BS PROVIDER PIN NUMBER
IN761022OtherUNITED CONCORDIA NUMBER
IN629810Medicare ID - Type UnspecifiedMEDICARE NUMBER
IN000000084417OtherBC BS PROVIDER PIN NUMBER