Healthcare Provider Details

I. General information

NPI: 1417489683
Provider Name (Legal Business Name): SUMITH JAMPANA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SUMI JAMPANA D.D.S.

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CENTRAL PARK S RM 7D
NEW YORK NY
10019-1628
US

IV. Provider business mailing address

132 E 35TH ST # 18C
NEW YORK NY
10016-3892
US

V. Phone/Fax

Practice location:
  • Phone: 212-486-7574
  • Fax:
Mailing address:
  • Phone: 718-250-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number059752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: