MEDICARE: DR. JAYANTH NALLURI DDS

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
1	122300000X	Dentist	2901602670	MI

General Provider Information

NPI Number	:	1821982372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYANTH NALLURI DDS

Provider Business Mailing Address
First Line	:	24302 AMANDA LN
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48375-5707
Country	:	US
Telephone Number	:	734-747-2920
Fax Number	:

Provider Business Practice Location Address
First Line	:	2829 E GRAND RIVER AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-4331
Country	:	US
Telephone Number	:	517-333-3160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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