Basic Information
| Provider Information | |||||||||
| NPI: | 1285737072 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIKAIN | ||||||||
| FirstName: | SHIVA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 DUNWOODY CHACE NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303286007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788362102 | ||||||||
| FaxNumber: | 7704410299 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 HOLCOMB BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300761618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788362102 | ||||||||
| FaxNumber: | 7704410299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN013352 | GA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | DN013352 | 01 | GA | DENTIST | OTHER |