Provider Demographics
NPI:1669660536
Name:JAGADEESAN, DHEEPA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DHEEPA
Middle Name:
Last Name:JAGADEESAN
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 1:7936 N MACARTHUR BLVD
Mailing Address - Street 2:APT 1129
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3742
Mailing Address - Country:US
Mailing Address - Phone:424-247-8708
Mailing Address - Fax:
Practice Address - Street 1:3010 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7770
Practice Address - Country:US
Practice Address - Phone:424-247-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist