Provider Demographics
NPI:1245758820
Name:SHREEGANESH, JAYASHREE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYASHREE
Middle Name:
Last Name:SHREEGANESH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28547 OAKMONTE CIR E
Mailing Address - Street 2:
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165
Mailing Address - Country:US
Mailing Address - Phone:718-673-7544
Mailing Address - Fax:
Practice Address - Street 1:26113 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1147
Practice Address - Country:US
Practice Address - Phone:586-393-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010224361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice