Provider Demographics
NPI:1821474602
Name:VYAS, ADITI
Entity Type:Individual
Prefix:DR
First Name:ADITI
Middle Name:
Last Name:VYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADITI
Other - Middle Name:
Other - Last Name:VYAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6766 BERNAL AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-1233
Mailing Address - Country:US
Mailing Address - Phone:848-468-9870
Mailing Address - Fax:
Practice Address - Street 1:6766 BERNAL AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-1233
Practice Address - Country:US
Practice Address - Phone:848-468-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist