Provider Demographics
NPI:1457643389
Name:JAYANETTI, JAY LEOPOLDO (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:LEOPOLDO
Last Name:JAYANETTI
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 1:10833 LE CONTE AVE
Mailing Address - Street 2:A0-156B CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-6510
Mailing Address - Fax:310-206-4201
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:A0-156B CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-6510
Practice Address - Fax:310-206-4201
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics