Provider Demographics
NPI:1336262229
Name:JHAVERI, VIRENDRA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRENDRA
Middle Name:L
Last Name:JHAVERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 KISSENA BLVD
Mailing Address - Street 2:SUITE #LE
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3769
Mailing Address - Country:US
Mailing Address - Phone:718-539-4465
Mailing Address - Fax:718-539-2801
Practice Address - Street 1:4370 KISSENA BLVD
Practice Address - Street 2:SUITE #LE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3769
Practice Address - Country:US
Practice Address - Phone:718-539-4465
Practice Address - Fax:718-539-2801
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045619-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01514823Medicaid