Provider Demographics
NPI:1831883834
Name:PRIYAMVARA, ADITI
Entity type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:PRIYAMVARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 MARTIN LUTHER KING JR HWY
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4016
Mailing Address - Country:US
Mailing Address - Phone:301-882-8888
Mailing Address - Fax:240-714-3755
Practice Address - Street 1:7023 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4016
Practice Address - Country:US
Practice Address - Phone:301-882-8888
Practice Address - Fax:240-714-3755
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist