Individual
RIA VIJ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3523 COMMERCIAL DR, FAIRLAWN, OH 44333-5107
(330) 668-9977
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
(330) 338-0330
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
30.027794
OH
1223P0221X
Pediatric Dentistry
Primary
30.027794
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2023
Last updated
07/15/2025
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