Provider Demographics
NPI:1003258427
Name:SUBBARAYA, GAYATHRI H (DMD)
Entity Type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:H
Last Name:SUBBARAYA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 LAKELAND HIGHLANDS RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4370
Mailing Address - Country:US
Mailing Address - Phone:863-665-1545
Mailing Address - Fax:863-665-1615
Practice Address - Street 1:2960 LAKELAND HIGHLANDS RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4370
Practice Address - Country:US
Practice Address - Phone:863-665-1545
Practice Address - Fax:863-665-1615
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN203091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice