Provider Demographics
NPI:1871959361
Name:JIGNA KHETANI DDS,INC
Entity type:Organization
Organization Name:JIGNA KHETANI DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIGNA
Authorized Official - Middle Name:KASHYAP
Authorized Official - Last Name:KHETANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-674-4745
Mailing Address - Street 1:2096 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4055
Mailing Address - Country:US
Mailing Address - Phone:408-674-4745
Mailing Address - Fax:
Practice Address - Street 1:2096 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4055
Practice Address - Country:US
Practice Address - Phone:408-674-4745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty