Individual
JAYAKUMAR SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
232 N PASEO DE ONATE, ESPANOLA, NM 87532-2623
(505) 753-7246
Mailing address
5401 KING ALBERT ST, SAN ANTONIO, TX 78229-5236
(210) 254-2362
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4800
NM
Other
Enumeration date
09/19/2017
Last updated
09/19/2017
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