Organization
DR. NANDAKA JAYAWEERA, DMD, PLLC
Active
Other names
Gentle Excellence Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NANDAKA JAYAWEERA DMD (OWNER)
(502) 368-8400
Entity
Organization
Contact information
Practice address
4133 TAYLOR BLVD, LOUISVILLE, KY 40215-2341
(502) 368-8400
(502) 368-8423
Mailing address
4133 TAYLOR BLVD, LOUISVILLE, KY 40215-2341
(502) 368-8400
(502) 368-8423
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8777
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750511259
NANDAKA JAYAWEERA'S NPI NUMBER
KY
01
—
45608247
EPSDT
KY
05
—
7100194630
—
KY
Enumeration date
03/21/2012
Last updated
09/23/2015
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