Provider Demographics
NPI:1043424310
Name:SRINIVASAN, JAYASHREE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAYASHREE
Middle Name:
Last Name:SRINIVASAN
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 1:7420 S RURAL RD STE B5
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4655
Mailing Address - Country:US
Mailing Address - Phone:480-838-1044
Mailing Address - Fax:480-838-6109
Practice Address - Street 1:7420 S RURAL RD STE B5
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4655
Practice Address - Country:US
Practice Address - Phone:480-838-1044
Practice Address - Fax:480-838-6109
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice