Provider Demographics
NPI:1619382439
Name:VYAS, DEEPA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:
Last Name:VYAS
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 1:16205 W 64TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7401
Mailing Address - Country:US
Mailing Address - Phone:303-940-8880
Mailing Address - Fax:303-456-1036
Practice Address - Street 1:16205 W 64TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7401
Practice Address - Country:US
Practice Address - Phone:303-940-8880
Practice Address - Fax:303-456-1036
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2022221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics