Healthcare Provider Details

I. General information

NPI: 1659115038
Provider Name (Legal Business Name): DR. SATYAVRAT ARYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W NATIONAL RD
VANDALIA OH
45377-1939
US

IV. Provider business mailing address

205 W NATIONAL RD
VANDALIA OH
45377-1939
US

V. Phone/Fax

Practice location:
  • Phone: 937-898-8990
  • Fax:
Mailing address:
  • Phone: 937-898-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027599
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.027599
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: