Provider Demographics
NPI:1518323708
Name:JAYA L DENTAL ARTS PLLC
Entity Type:Organization
Organization Name:JAYA L DENTAL ARTS PLLC
Other - Org Name:ADVANCED DENTAL AND TMJ CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:ADATROW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-606-2800
Mailing Address - Street 1:399 SOUTHCREST CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4790
Mailing Address - Country:US
Mailing Address - Phone:901-606-2800
Mailing Address - Fax:
Practice Address - Street 1:399 SOUTHCREST CT
Practice Address - Street 2:SUITE C
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4790
Practice Address - Country:US
Practice Address - Phone:901-606-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental