Individual
DR. NANDAKA A JAYAWEERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4133 TAYLOR BLVD, LOUISVILLE, KY 40215-2341
(502) 368-8400
Mailing address
4133 TAYLOR BLVD, LOUISVILLE, KY 40215-2341
(502) 368-8400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8777
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100194630
—
KY
Enumeration date
07/17/2009
Last updated
09/25/2015
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