Provider Demographics
NPI:1356606255
Name:VYAS, HARSHIV J (BDS, MDS)
Entity type:Individual
Prefix:DR
First Name:HARSHIV
Middle Name:J
Last Name:VYAS
Suffix:
Gender:M
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4685
Mailing Address - Country:US
Mailing Address - Phone:708-349-4000
Mailing Address - Fax:888-334-0111
Practice Address - Street 1:15300 WEST AVE STE 113
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4685
Practice Address - Country:US
Practice Address - Phone:708-349-4000
Practice Address - Fax:888-334-0111
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0309341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery