Provider Demographics
NPI:1437510559
Name:JAGAN, CHEDDI BRADLAUGH (DDS)
Entity Type:Individual
Prefix:MR
First Name:CHEDDI
Middle Name:BRADLAUGH
Last Name:JAGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 LIBERTY AVE
Mailing Address - Street 2:2B
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1902
Mailing Address - Country:US
Mailing Address - Phone:917-657-3901
Mailing Address - Fax:
Practice Address - Street 1:11512 LIBERTY AVE
Practice Address - Street 2:2B
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1902
Practice Address - Country:US
Practice Address - Phone:917-657-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist