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General NPI Number Information
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NPI Number | 1316267115
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Entity Type | Individual
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Provider Name | VAISHNAVI RAVINDRAN IYER BDS, MPH, DDS
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1150 SPRINGFIELD AVE
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City | IRVINGTON
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State | NJ
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Zip | 07111-2441
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Country | US
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Telephone | 973-483-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 16 GARRITY TER
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City | PINE BROOK
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State | NJ
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Zip | 07058-9640
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Country | US
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Telephone | 661-444-8992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25004
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI03033300
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License Number State | NJ
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