Niva Dental Specialists PLLC
Dentist, Oral and Maxillofacial Surgery in Leander, TX. Organization (NPI-2).
NPI number1194436634
StatusActive
Last updated in NPPESDec 6, 2022
Details
- NPI
- 1194436634
- Entity type
- Organization (NPI-2)
- Legal business name
- Niva Dental Specialists PLLC
- Organization subpart
- No
- Enumeration date
- Dec 6, 2022
- Certification date
- Dec 2, 2022
- Last updated
- Dec 6, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | – | – | Yes |
| 1223E0200X | Dentist, Endodontics | – | – | |
| 1223P0300X | Dentist, Periodontics | – | – |
Practice location
15141 Ronald Reagan BlvdSuite 516
Leander, TX 78641-7864
Phone 512-881-8852 · Fax 512-881-7721
Mailing address
1511 Rimstone DrCedar Park, TX 78613-7692
Phone 630-267-1199
Authorized official
Shouvik Ponnusamy
Owner
6302671199
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