Provider Demographics
NPI:1033464128
Name:JAWANDHA, JATINDER SINGH (DMD)
Entity Type:Individual
Prefix:
First Name:JATINDER
Middle Name:SINGH
Last Name:JAWANDHA
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 1:120 WYLLIS AVE
Mailing Address - Street 2:UNIT#413
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-1149
Mailing Address - Country:US
Mailing Address - Phone:417-379-2218
Mailing Address - Fax:
Practice Address - Street 1:120 WYLLIS AVE
Practice Address - Street 2:UNIT#413
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-1149
Practice Address - Country:US
Practice Address - Phone:417-379-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist