Provider Demographics
NPI:1508395849
Name:NAYAK, ASHISH (DDS)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:NAYAK
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 1:392 GARRISONVILLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1576
Mailing Address - Country:US
Mailing Address - Phone:540-659-6816
Mailing Address - Fax:
Practice Address - Street 1:392 GARRISONVILLE RD STE 205
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1576
Practice Address - Country:US
Practice Address - Phone:540-659-6816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014181421223G0001X
IN12012753A1223G0001X
IL0190314651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370966854022Medicaid