Provider Demographics
NPI:1588812341
Name:JANORKAR, DEEPTI AMOL (BDS)
Entity type:Individual
Prefix:
First Name:DEEPTI
Middle Name:AMOL
Last Name:JANORKAR
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 ROSENEATH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39203-2052
Mailing Address - Country:US
Mailing Address - Phone:601-608-0050
Mailing Address - Fax:
Practice Address - Street 1:275 ROSENEATH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39203-2052
Practice Address - Country:US
Practice Address - Phone:601-608-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3574-10122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05836742Medicaid