Provider Demographics
NPI:1013025584
Name:KYATAM, JAYASHREE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAYASHREE
Middle Name:
Last Name:KYATAM
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 1:9900 W. PARMER LN
Mailing Address - Street 2:SUITE A-205
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717
Mailing Address - Country:US
Mailing Address - Phone:512-388-1833
Mailing Address - Fax:512-388-1838
Practice Address - Street 1:9900 W PARMER LN STE A205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4909
Practice Address - Country:US
Practice Address - Phone:512-388-1833
Practice Address - Fax:512-388-1838
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist