Healthcare Provider Details

I. General information

NPI: 1083801880
Provider Name (Legal Business Name): JEEVAN KUMAR YENUGANTI BDS, MSPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JEEVAN K YENUGANTI ORAL MEDICINE & GPR

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 ELYSIAN FIELDS AVE
NEW ORLEANS LA
70117-8208
US

IV. Provider business mailing address

2357 ORMOND BLVD
DESTREHAN LA
70047-2103
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-2601
  • Fax: 888-736-9806
Mailing address:
  • Phone: 504-638-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6421
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: