Provider Demographics
NPI:1437559663
Name:KSHATRIYA, PAYAL (DDS)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:KSHATRIYA
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 1:6040 KENNEDY BLVD E
Mailing Address - Street 2:APT MF
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-3825
Mailing Address - Country:US
Mailing Address - Phone:203-727-0024
Mailing Address - Fax:
Practice Address - Street 1:6418 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1621
Practice Address - Country:US
Practice Address - Phone:201-868-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025819001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice