Provider Demographics
NPI:1679738892
Name:SHRIPAD, JAYALAKSHMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAYALAKSHMI
Middle Name:
Last Name:SHRIPAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S. UNION AVENUE
Mailing Address - Street 2:UNION DENTAL CENTER
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078
Mailing Address - Country:US
Mailing Address - Phone:410-939-3950
Mailing Address - Fax:410-939-3950
Practice Address - Street 1:201 S. UNION AVENUE
Practice Address - Street 2:UNION DENTAL CENTER
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078
Practice Address - Country:US
Practice Address - Phone:410-939-3950
Practice Address - Fax:410-939-3950
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist