Provider Demographics
NPI:1609429273
Name:JAMPALA, NAVYA (DDS)
Entity Type:Individual
Prefix:
First Name:NAVYA
Middle Name:
Last Name:JAMPALA
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 1:10891 CREEKBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5108
Mailing Address - Country:US
Mailing Address - Phone:682-215-8837
Mailing Address - Fax:
Practice Address - Street 1:10891 CREEKBRIDGE PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-5108
Practice Address - Country:US
Practice Address - Phone:682-215-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist