Individual
DR. JYOTHI G KUDASOMANNAVAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
10371 PARKGLENN WAY STE 250, PARKER, CO 80138-3871
(303) 840-1900
Mailing address
20293 E BELLEVIEW PL, CENTENNIAL, CO 80015-5226
(614) 519-1190
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
30.023776
OH
1223G0001X
General Practice Dentistry
Primary
DEN.00202795
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0066756
—
CO
Enumeration date
06/20/2012
Last updated
06/26/2023
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