Provider Demographics
NPI:1447422720
Name:K JAYADEVAN DDS
Entity Type:Organization
Organization Name:K JAYADEVAN DDS
Other - Org Name:DENTAL HEALTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNASWAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYADEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-567-8899
Mailing Address - Street 1:5801 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4841
Mailing Address - Country:US
Mailing Address - Phone:631-567-8899
Mailing Address - Fax:631-567-8118
Practice Address - Street 1:5801 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4841
Practice Address - Country:US
Practice Address - Phone:631-567-8899
Practice Address - Fax:631-567-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty