Provider Demographics
NPI:1316267115
Name:IYER, VAISHNAVI RAVINDRAN (BDS, MPH, DDS)
Entity type:Individual
Prefix:DR
First Name:VAISHNAVI
Middle Name:RAVINDRAN
Last Name:IYER
Suffix:
Gender:F
Credentials:BDS, MPH, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GARRITY TER
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9640
Mailing Address - Country:US
Mailing Address - Phone:661-444-8992
Mailing Address - Fax:
Practice Address - Street 1:1150 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2441
Practice Address - Country:US
Practice Address - Phone:973-483-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250041223G0001X
NJ22DI030333001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1013793Medicaid
TX212704505Medicaid