Provider Demographics
NPI:1720487135
Name:SHYAMSUNDER, NODESH (BDS)
Entity Type:Individual
Prefix:DR
First Name:NODESH
Middle Name:
Last Name:SHYAMSUNDER
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5602
Mailing Address - Country:US
Mailing Address - Phone:904-246-6714
Mailing Address - Fax:
Practice Address - Street 1:324 3RD AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5602
Practice Address - Country:US
Practice Address - Phone:904-246-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN209071223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics