Provider Demographics
NPI:1336875111
Name:JAY I. BHATT DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAY I. BHATT DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYANT
Authorized Official - Middle Name:I
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-896-2957
Mailing Address - Street 1:1401 AVOCADO AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8733
Mailing Address - Country:US
Mailing Address - Phone:949-759-7007
Mailing Address - Fax:949-644-0446
Practice Address - Street 1:1401 AVOCADO AVE STE 309
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8733
Practice Address - Country:US
Practice Address - Phone:949-759-7007
Practice Address - Fax:949-644-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33064OtherDENTIST