Provider Demographics
NPI:1578948287
Name:VIJAYAN, SUVENDRA (BDS, MPH)
Entity Type:Individual
Prefix:
First Name:SUVENDRA
Middle Name:
Last Name:VIJAYAN
Suffix:
Gender:M
Credentials:BDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S. DENTAL SCIENCE BLDG,
Mailing Address - Street 2:OPRM S386 DSB
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1001
Mailing Address - Country:US
Mailing Address - Phone:319-335-7362
Mailing Address - Fax:
Practice Address - Street 1:322 S. DENTAL SCIENCE BLDG,
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1001
Practice Address - Country:US
Practice Address - Phone:319-335-7440
Practice Address - Fax:319-335-7451
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARES-304481223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology