Provider Demographics
NPI:1548465339
Name:JAY PLATT DDS PC
Entity type:Organization
Organization Name:JAY PLATT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-864-1133
Mailing Address - Street 1:322 INDIANAPOLIS BOULEVARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2656
Mailing Address - Country:US
Mailing Address - Phone:219-864-1133
Mailing Address - Fax:219-864-9203
Practice Address - Street 1:322 INDIANAPOLIS BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2656
Practice Address - Country:US
Practice Address - Phone:219-864-1133
Practice Address - Fax:219-864-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008814A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty