MEDICARE: THEYYAR R JAN DDS,PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN14363	FL

General Provider Information

NPI Number	:	1144686098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEYYAR R JAN DDS,PA

Provider Business Mailing Address
First Line	:	1949 ISLA DE PALMA CIR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-3403
Country	:	US
Telephone Number	:	239-594-2012
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 W COLONIAL DR
Second Line	:	SUITE 6901 HIAWASSEE PROF. BLDG
City	:	ORLANDO
State	:	FL
Zip	:	32818-6829
Country	:	US
Telephone Number	:	407-292-8767
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THEYYAR RANGARAJAN
Credential	:	D.D.S
Telephone Number	:	239-594-2012

Provider Enumeration Date	:	01/07/2016
Last Update Date	:	01/07/2016

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