Provider Demographics
NPI:1366072936
Name:JAIN, TEERTHESH (DDS)
Entity type:Individual
Prefix:DR
First Name:TEERTHESH
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13335 FIELDING WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4612
Mailing Address - Country:US
Mailing Address - Phone:720-454-9057
Mailing Address - Fax:
Practice Address - Street 1:8028 S EMERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9301
Practice Address - Country:US
Practice Address - Phone:317-893-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032478122300000X
CODEN.00204264122300000X, 1223G0001X
TX35921122300000X
IN12013524A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice