Provider Demographics
NPI:1225619398
Name:RAIYANI, PRIYANKA PRAVIN (BDS, MDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:PRAVIN
Last Name:RAIYANI
Suffix:
Gender:F
Credentials:BDS, MDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 PEAR TREE LN STE 120
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6485
Mailing Address - Country:US
Mailing Address - Phone:707-258-6128
Mailing Address - Fax:707-254-1779
Practice Address - Street 1:300 HARTLE CT
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-4078
Practice Address - Country:US
Practice Address - Phone:707-254-1775
Practice Address - Fax:707-254-1779
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61142655122300000X
CA108305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist