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General NPI Number Information
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NPI Number | 1144686098
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Entity Type | Organization
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Legal Business Name | THEYYAR R JAN DDS,PA
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 6901 W COLONIAL DR SUITE 6901 HIAWASSEE PROF. BLDG
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City | ORLANDO
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State | FL
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Zip | 32818-6829
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Country | US
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Telephone | 407-292-8767
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Fax |
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Provider Business Mailing Address
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Address Line | 1949 ISLA DE PALMA CIR
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City | NAPLES
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State | FL
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Zip | 34119-3403
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Country | US
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Telephone | 239-594-2012
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEYYAR RANGARAJAN
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Credential | D.D.S
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Telephone | 239-594-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN14363
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License Number State | FL
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