Provider Demographics
NPI:1013131424
Name:JAYANT I. BHATT, DDS
Entity Type:Organization
Organization Name:JAYANT I. BHATT, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ARACELI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-861-2811
Mailing Address - Street 1:1111 GRAND AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4171
Mailing Address - Country:US
Mailing Address - Phone:909-861-2811
Mailing Address - Fax:909-396-1532
Practice Address - Street 1:1111 GRAND AVE
Practice Address - Street 2:SUITE I
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4171
Practice Address - Country:US
Practice Address - Phone:909-861-2811
Practice Address - Fax:909-396-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty