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General NPI Number Information
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NPI Number | 1548535776
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Entity Type | Organization
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Legal Business Name | DR. NANDAKA JAYAWEERA, DMD, PLLC
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 4133 TAYLOR BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40215-2341
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Country | US
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Telephone | 502-368-8400
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Fax | 502-368-8423
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Provider Business Mailing Address
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Address Line | 4133 TAYLOR BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40215-2341
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Country | US
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Telephone | 502-368-8400
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Fax | 502-368-8423
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Authorized Official
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Title or Position | OWNER
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Name | MR. NANDAKA JAYAWEERA
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Credential | DMD
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Telephone | 502-368-8400
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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 | 8777
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License Number State | KY
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