Provider Demographics
NPI:1407995608
Name:VYAS, PRAKASH M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:M
Last Name:VYAS
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 1:125 PINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1856
Mailing Address - Country:US
Mailing Address - Phone:845-473-5639
Mailing Address - Fax:
Practice Address - Street 1:10 ROSS CIR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1078
Practice Address - Country:US
Practice Address - Phone:845-483-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0369671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice