Provider Demographics
NPI:1013957281
Name:YAPA, JEEVAKA (DDS)
Entity type:Individual
Prefix:
First Name:JEEVAKA
Middle Name:
Last Name:YAPA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29425 NORTHWESTERN HWY STE. 330
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-262-9100
Mailing Address - Fax:248-262-9104
Practice Address - Street 1:30555 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1594
Practice Address - Country:US
Practice Address - Phone:248-262-9100
Practice Address - Fax:248-262-9104
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI160261223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457523755OtherGROUP NPI
MI2901016026OtherSTATE LICENSE
MI2901016026OtherSTATE LICENSE