Provider Demographics
NPI:1578948287
Name:VIJAYAN, SUVENDRA (BDS, MPH, MS)
Entity type:Individual
Prefix:DR
First Name:SUVENDRA
Middle Name:
Last Name:VIJAYAN
Suffix:
Gender:M
Credentials:BDS, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 TERRACE ST
Mailing Address - Street 2:SALK ANNEX G119
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2523
Mailing Address - Country:US
Mailing Address - Phone:412-624-2053
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE ST
Practice Address - Street 2:SALK ANNEX G119
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2523
Practice Address - Country:US
Practice Address - Phone:412-624-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARFD0000321223X0008X
IARES-304481223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology