Provider Demographics
NPI:1134812449
Name:JYOTIKA, UNKNOWN
Entity type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:JYOTIKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JYOTIKA
Other - Middle Name:
Other - Last Name:DHIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:903 QUAINT PARISH CIR
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-3277
Mailing Address - Country:US
Mailing Address - Phone:908-494-0315
Mailing Address - Fax:
Practice Address - Street 1:1119 S CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-2094
Practice Address - Country:US
Practice Address - Phone:908-494-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI2901602758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program