Provider Demographics
NPI:1114749934
Name:DIYA DENTAL SERVICES LLC
Entity type:Organization
Organization Name:DIYA DENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDAN
Authorized Official - Middle Name:VENKATESH
Authorized Official - Last Name:REDDY SALUKOOTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-809-6688
Mailing Address - Street 1:193 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1164
Mailing Address - Country:US
Mailing Address - Phone:732-809-6688
Mailing Address - Fax:
Practice Address - Street 1:2177 OAK TREE RD STE 101
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1082
Practice Address - Country:US
Practice Address - Phone:732-809-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty