Provider Demographics
NPI:1013072115
Name:DESHMANE, JYOTI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:
Last Name:DESHMANE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAMELOT WAY
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2910
Mailing Address - Country:US
Mailing Address - Phone:215-368-3813
Mailing Address - Fax:610-222-8121
Practice Address - Street 1:2012 BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474-0137
Practice Address - Country:US
Practice Address - Phone:610-222-8189
Practice Address - Fax:610-222-8121
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028689L1223G0001X
PADS-028689L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1926Medicaid
PA784857OtherUCCI PROV. ID
PA000000262309Medicaid