Provider Demographics
NPI:1689421224
Name:JCYARAM DENTAL PC
Entity type:Organization
Organization Name:JCYARAM DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:GADHIYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-808-5845
Mailing Address - Street 1:244 SPRING HILL RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5176
Mailing Address - Country:US
Mailing Address - Phone:248-808-5845
Mailing Address - Fax:
Practice Address - Street 1:5444 FM 423 STE 600
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-7181
Practice Address - Country:US
Practice Address - Phone:214-308-5359
Practice Address - Fax:214-975-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty