Provider Demographics
NPI:1679602866
Name:JAYAWARDENA, JOSEPH M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:JAYAWARDENA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 GIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3702
Mailing Address - Country:US
Mailing Address - Phone:845-561-1969
Mailing Address - Fax:845-561-1921
Practice Address - Street 1:407 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3702
Practice Address - Country:US
Practice Address - Phone:845-561-1969
Practice Address - Fax:845-561-1921
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0390981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice