Provider Demographics
NPI:1366825457
Name:VASA, PRIYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:VASA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 555
Mailing Address - Street 2:HARDWICK DENTAL GROUP, P.C.
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843
Mailing Address - Country:US
Mailing Address - Phone:802-472-5005
Mailing Address - Fax:
Practice Address - Street 1:49 WEST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:401-457-3018
Practice Address - Fax:401-457-3375
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01190591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice