Healthcare Provider Details

I. General information

NPI: 1720154495
Provider Name (Legal Business Name): NIVEN T TIEN DDS,MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 50TH ST NW STE 200
WASHINGTON DC
20016-4396
US

IV. Provider business mailing address

14955 SHADY GROVE ROAD SUITE 330
NORTH BETHESDA MD
20850-8720
US

V. Phone/Fax

Practice location:
  • Phone: 202-360-4032
  • Fax:
Mailing address:
  • Phone: 301-340-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN1001223
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number14962
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD044528
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberD0075315
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: