Healthcare Provider Details

I. General information

NPI: 1174540082
Provider Name (Legal Business Name): NISHI H VAKHARIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15432 W GREENWAY RD
SURPRISE AZ
85374-4365
US

IV. Provider business mailing address

15432 W GREENWAY RD STE 100
SURPRISE AZ
85374-4366
US

V. Phone/Fax

Practice location:
  • Phone: 623-274-2796
  • Fax:
Mailing address:
  • Phone: 623-274-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012682
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: