Provider Demographics
NPI:1326265943
Name:KONDAMANI, JAYANTHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYANTHI
Middle Name:
Last Name:KONDAMANI
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 1:25 PIERREPONT ST
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3366
Mailing Address - Country:US
Mailing Address - Phone:718-797-9894
Mailing Address - Fax:
Practice Address - Street 1:133 MORNINGSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-923-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice