Active NPI
Bhavana Jayaram, DMD
- General Practice Dentistry
- Lawrence, MA
National Provider Identifier
1194873489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 21404
- Practice address
- 73C Winthrop Ave
Lawrence, MA 01843-3716 - Phone
- (978) 725-6525
- NPI assigned
- Jan 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 21404 | MA | Primary |
Addresses
Primary practice location
73C Winthrop Ave
Lawrence, MA 01843-3716
Mailing address
201 W 8TH St
Suite 810
Pueblo, CO 81003-3038
Phone (719) 562-4447
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0204803 | Medicaid | MA | |
| 30303623 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21404 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293494400000",
"number": "1194873489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W 8TH ST",
"address_2": "SUITE 810",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810033038",
"telephone_number": "719-562-4447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "73C WINTHROP AVE",
"city": "LAWRENCE",
"state": "MA",
"postal_code": "018433716",
"telephone_number": "978-725-6525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAYARAM",
"first_name": "BHAVANA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2010-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "21404",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0204803",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30303623",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrence, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.