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General NPI Number Information
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NPI Number | 1023582152
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Entity Type | Individual
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Provider Name | AVASA NALINI JAGAN DDS
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Gender | Female
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 11512 LIBERTY AVE STE 2B
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City | JAMAICA
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State | NY
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Zip | 11419-1902
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Country | US
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Telephone | 929-499-3287
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Fax |
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Provider Business Mailing Address
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Address Line | 2838 STILLWELL AVE APT 3B
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City | BROOKLYN
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State | NY
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Zip | 11224-2685
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Country | US
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Telephone | 347-320-1770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 060613
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License Number State | NY
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