Provider Demographics
NPI:1356996706
Name:PUPNEJA, JYOTI
Entity type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:
Last Name:PUPNEJA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JYOTI
Other - Middle Name:
Other - Last Name:DHANKHAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3410 N HIGH SCHOOL RD STE B&F
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-1742
Mailing Address - Country:US
Mailing Address - Phone:317-222-5143
Mailing Address - Fax:317-746-6954
Practice Address - Street 1:3410 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-1742
Practice Address - Country:US
Practice Address - Phone:317-222-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013176B1223G0001X
GADN1229621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice