Provider Demographics
NPI:1740297480
Name:JEYASRI GUNARAJASINGAM DMD
Entity type:Organization
Organization Name:JEYASRI GUNARAJASINGAM DMD
Other - Org Name:<UNAVAIL>
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:617-922-8555
Mailing Address - Street 1:JEYASRI. GUNARAJASINGAM DMD
Mailing Address - Street 2:61 EVERETT AVE
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150
Mailing Address - Country:US
Mailing Address - Phone:617-922-8555
Mailing Address - Fax:617-466-1356
Practice Address - Street 1:CHELSEA DENTAL PC
Practice Address - Street 2:61 EVERETT AVE
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150
Practice Address - Country:US
Practice Address - Phone:617-922-8555
Practice Address - Fax:617-466-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17100261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9738428Medicaid