Provider Demographics
NPI:1851320097
Name:JEYASRI GUNARAJASINGAM DMD PC
Entity Type:Organization
Organization Name:JEYASRI GUNARAJASINGAM DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEYASRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNARAJASINGAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-884-4444
Mailing Address - Street 1:100 EVERETT AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2328
Mailing Address - Country:US
Mailing Address - Phone:617-884-4444
Mailing Address - Fax:617-466-1356
Practice Address - Street 1:100 EVERETT AVE
Practice Address - Street 2:UNIT 5 DENTAL HEALTH INT
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150
Practice Address - Country:US
Practice Address - Phone:617-884-4444
Practice Address - Fax:617-884-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9763791Medicaid