Individual
BHAVANA JAYARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
73C WINTHROP AVE, LAWRENCE, MA 01843-3716
(978) 725-6525
Mailing address
201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
(719) 562-4447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21404
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0204803
—
MA
05
—
30303623
—
NH
Enumeration date
01/05/2007
Last updated
12/28/2010
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