Provider Demographics
NPI:1740552140
Name:KHETANI, JIGNA K (DDS)
Entity type:Individual
Prefix:
First Name:JIGNA
Middle Name:K
Last Name:KHETANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 TRADEWINDS DR
Mailing Address - Street 2:APT 6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-6026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 TRADEWINDS DR
Practice Address - Street 2:APT 6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6026
Practice Address - Country:US
Practice Address - Phone:408-674-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice