Provider Demographics
NPI:1699384834
Name:THORAT, JAYASHREE RAJESH (DDS)
Entity type:Individual
Prefix:
First Name:JAYASHREE
Middle Name:RAJESH
Last Name:THORAT
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 1:5210 VILLA WAY APT 356
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2150
Mailing Address - Country:US
Mailing Address - Phone:330-313-9332
Mailing Address - Fax:
Practice Address - Street 1:6416 CARLISLE PIKE STE 500
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2884
Practice Address - Country:US
Practice Address - Phone:717-766-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042822122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist