Provider Demographics
NPI:1790150480
Name:VYAS, NAYANKUMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAYANKUMAR
Middle Name:
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 1:511 RANSOM ST
Mailing Address - Street 2:APT # D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2284
Mailing Address - Country:US
Mailing Address - Phone:919-599-4143
Mailing Address - Fax:
Practice Address - Street 1:6150 E 82ND ST
Practice Address - Street 2:100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1500
Practice Address - Country:US
Practice Address - Phone:317-577-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-06
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012345A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice