MEDICARE: DR. AMBER KIYANI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	RES.3074	OH

General Provider Information

NPI Number	:	1770925380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER KIYANI DDS

Provider Business Mailing Address
First Line	:	305 W 12TH AVE
Second Line	:	ROOM 2196
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-292-6577
Fax Number	:	614-292-9384

Provider Business Practice Location Address
First Line	:	305 W 12TH AVE
Second Line	:	ROOM 2196
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-292-6577
Fax Number	:	614-292-9384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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