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NPI Code Detail

MEDICARE: DR. JAY KANSAL DMD

MEDICARE: DR. JAY KANSAL DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN013686GA

General Provider Information

NPI Number : 1548464381
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAY KANSAL DMD
Provider Business Mailing Address
First Line : 2480 WINDY HILL RD SE STE 405
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8658
Country : US
Telephone Number : 770-952-0136
Fax Number :
Provider Business Practice Location Address
First Line : 2480 WINDY HILL RD SE STE 405
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8658
Country : US
Telephone Number : 770-952-0136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2007
Last Update Date : 05/20/2013

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