Provider Demographics
NPI:1639855679
Name:GAJERA, JYOTIBEN GORDHANBHAI
Entity type:Individual
Prefix:
First Name:JYOTIBEN
Middle Name:GORDHANBHAI
Last Name:GAJERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E GRUBB DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2598
Mailing Address - Country:US
Mailing Address - Phone:469-999-3096
Mailing Address - Fax:
Practice Address - Street 1:7423 LAS COLINAS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7565
Practice Address - Country:US
Practice Address - Phone:469-845-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41593122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program