MEDICARE: DR. SHALINI NAIR D.M.D

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	22DI02394000	NJ
2	122300000X	Dentist	DN014356	GA

General Provider Information

NPI Number	:	1013148303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHALINI NAIR D.M.D

Provider Business Mailing Address
First Line	:	1155 LAVISTA RD NE
Second Line	:	APT 2426
City	:	ATLANTA
State	:	GA
Zip	:	30324-3738
Country	:	US
Telephone Number	:	732-763-5843
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 LAVISTA RD NE
Second Line	:	APT 2426
City	:	ATLANTA
State	:	GA
Zip	:	30324-3738
Country	:	US
Telephone Number	:	732-763-5843
Fax Number	:

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

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	04/05/2012

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