NPI 1023509395

Jyotirmaie Suryadevara, DMDMS

Practitioner Periodontics Fpo, AP

Practice location

Address: 3d Den Bn 3d Mlg Unit 38450, Fpo, AP 96373-8450
Phone: (973) 641-5433

Registered specialties

Periodontics Primary

Dental Providers Taxonomy 1223P0300X Licence 019.034186 (IL)

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Registry record

NPI: 1023509395
Entity type: Individual
Sex (as registered): Female
NPI issued: 22 May 2018
Record last updated: 21 Jul 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.