Individual
DR. CHANNA D JAYATILAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, PH.D
Contact information
Practice address
109 CARLETON AVE, CENTRAL ISLIP, NY 11722-3616
(631) 348-2500
Mailing address
3 BELWYN LN, SOUTH SETAUKET, NY 11720-1408
(631) 732-4396
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
048111
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02145971
—
NY
Enumeration date
07/19/2007
Last updated
07/19/2007
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