Provider Demographics
NPI:1295931475
Name:DAVE, JALPA HARVADAN (DMD)
Entity type:Individual
Prefix:
First Name:JALPA
Middle Name:HARVADAN
Last Name:DAVE
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 1:805 GLYNN ST S
Mailing Address - Street 2:SUITE#131
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2000
Mailing Address - Country:US
Mailing Address - Phone:770-460-6651
Mailing Address - Fax:
Practice Address - Street 1:805 GLYNN ST S
Practice Address - Street 2:SUITE#131
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2000
Practice Address - Country:US
Practice Address - Phone:770-460-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist