Provider Demographics
NPI:1770703647
Name:KENCHETTY, JAISHANKAR N (BDS)
Entity type:Individual
Prefix:DR
First Name:JAISHANKAR
Middle Name:N
Last Name:KENCHETTY
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 1:532 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2533
Mailing Address - Country:US
Mailing Address - Phone:714-774-6281
Mailing Address - Fax:714-774-6707
Practice Address - Street 1:532 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2533
Practice Address - Country:US
Practice Address - Phone:714-774-6281
Practice Address - Fax:714-774-6707
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice