Provider Demographics
NPI:1760577316
Name:SRINIVASAN, JAYASRI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAYASRI
Middle Name:
Last Name:SRINIVASAN
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 1:655 237TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-3632
Mailing Address - Country:US
Mailing Address - Phone:678-471-3028
Mailing Address - Fax:
Practice Address - Street 1:655 237TH PL SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-3632
Practice Address - Country:US
Practice Address - Phone:678-471-3028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012404122300000X
GADE60521366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist