Provider Demographics
NPI:1619160199
Name:SERENITY DENTAL
Entity Type:Organization
Organization Name:SERENITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYGANESH
Authorized Official - Middle Name:MANOJ
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-305-3200
Mailing Address - Street 1:3341 E QUEEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8501
Mailing Address - Country:US
Mailing Address - Phone:480-305-3200
Mailing Address - Fax:
Practice Address - Street 1:3341 E QUEEN CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8501
Practice Address - Country:US
Practice Address - Phone:480-305-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBB9405689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty