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General NPI Number Information
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NPI Number | 1043424310
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Entity Type | Individual
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Provider Name | JAYASHREE SRINIVASAN DMD
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 7420 S RURAL RD STE B5
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City | TEMPE
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State | AZ
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Zip | 85283-4655
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Country | US
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Telephone | 480-838-1044
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Fax | 480-838-6109
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Provider Business Mailing Address
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Address Line | 7420 S RURAL RD STE B5
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City | TEMPE
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State | AZ
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Zip | 85283-4655
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Country | US
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Telephone | 480-838-1044
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Fax | 480-838-6109
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5266
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License Number State | AZ
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