Healthcare Provider Details

I. General information

NPI: 1073468054
Provider Name (Legal Business Name): NIKHITA SHARAN BASAPPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 BIRDCAGE CENTRE LN STE D105
CITRUS HEIGHTS CA
95610-8007
US

IV. Provider business mailing address

5925 BIRDCAGE ST STE D105
CITRUS HEIGHTS CA
95610-6875
US

V. Phone/Fax

Practice location:
  • Phone: 424-440-5637
  • Fax:
Mailing address:
  • Phone: 424-440-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: