Healthcare Provider Details

I. General information

NPI: 1457530651
Provider Name (Legal Business Name): NIDHI JAIN BDS, DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 EAST BIDWELL, SUITE 150
FOLSOM CA
95630
US

IV. Provider business mailing address

9309 OFFICE PARK CIRCLE, SUITE 120
ELK GROVE CA
95758
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-1109
  • Fax: 916-984-1764
Mailing address:
  • Phone: 916-691-1050
  • Fax: 916-691-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number56089
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number56089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: