Provider Demographics
NPI:1801183165
Name:JAINANDAN, KENNETH RAJIV (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RAJIV
Last Name:JAINANDAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 N. FLORIDA AVE, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604
Mailing Address - Country:US
Mailing Address - Phone:813-578-7887
Mailing Address - Fax:
Practice Address - Street 1:6008 N. FLORIDA AVE, SUITE 110
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604
Practice Address - Country:US
Practice Address - Phone:813-578-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist