Provider Demographics
NPI:1518088905
Name:JAYAPRAKASH, KRITHIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRITHIKA
Middle Name:
Last Name:JAYAPRAKASH
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 1:170 UNION ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3020
Mailing Address - Country:US
Mailing Address - Phone:860-375-3605
Mailing Address - Fax:
Practice Address - Street 1:170 UNION ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3020
Practice Address - Country:US
Practice Address - Phone:860-875-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106481223G0001X
TX23142122300000X
CA54540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice