Provider Demographics
NPI:1942738026
Name:JATTAN, ANDREW ANIL (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ANIL
Last Name:JATTAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 KERRY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-9210
Mailing Address - Country:US
Mailing Address - Phone:707-718-8062
Mailing Address - Fax:
Practice Address - Street 1:343 WARRIOR RD
Practice Address - Street 2:DENTAL CLINIC 3 BLDG 2115
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist