Provider Demographics
NPI:1881065613
Name:JANI, KRISHNA (DDS)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:JANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 VIRGINIA AVE NW
Mailing Address - Street 2:SUITE D104
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2440 VIRGINIA AVE NW
Practice Address - Street 2:SUITE D104
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2601
Practice Address - Country:US
Practice Address - Phone:202-223-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist