Provider Demographics
NPI:1942395272
Name:SELVAN, VAIDYA (BDS,DDS, MAGD)
Entity Type:Individual
Prefix:DR
First Name:VAIDYA
Middle Name:
Last Name:SELVAN
Suffix:
Gender:M
Credentials:BDS,DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 THROCKMORTON LN STE 201
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2558
Mailing Address - Country:US
Mailing Address - Phone:732-679-8300
Mailing Address - Fax:732-334-1080
Practice Address - Street 1:28 THROCKMORTON LN STE 201
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2558
Practice Address - Country:US
Practice Address - Phone:732-679-8300
Practice Address - Fax:732-334-1080
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01853000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist