Provider Demographics
NPI:1205225042
Name:VYAS, ELLEN WALTER (DDS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:WALTER
Last Name:VYAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20269 E SMOKY HILL RD
Mailing Address - Street 2:UNIT H
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3111
Mailing Address - Country:US
Mailing Address - Phone:303-617-5730
Mailing Address - Fax:303-617-5729
Practice Address - Street 1:20269 E SMOKY HILL RD
Practice Address - Street 2:UNIT H
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3111
Practice Address - Country:US
Practice Address - Phone:303-617-5730
Practice Address - Fax:303-617-5729
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2024291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice