Healthcare Provider Details

I. General information

NPI: 1477971919
Provider Name (Legal Business Name): PRIYANKA IYER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S LAKEWOOD DR
BRANDON FL
33511-2815
US

IV. Provider business mailing address

13110 ELK MOUNTAIN DR
RIVERVIEW FL
33579-7182
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-6292
  • Fax: 813-938-6426
Mailing address:
  • Phone: 813-653-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: