MEDICARE: DR. NAYANKUMAR VYAS D.D.S

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	1223G0001X	General Practice Dentistry	12012345A	IN

General Provider Information

NPI Number	:	1790150480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAYANKUMAR VYAS D.D.S

Provider Business Mailing Address
First Line	:	511 RANSOM ST
Second Line	:	APT # D
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2284
Country	:	US
Telephone Number	:	919-599-4143
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 E 82ND ST
Second Line	:	100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1500
Country	:	US
Telephone Number	:	317-577-5758
Fax Number	:

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

Provider Enumeration Date	:	12/06/2015
Last Update Date	:	12/06/2015

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