Healthcare Provider Details

I. General information

NPI: 1538179049
Provider Name (Legal Business Name): VIVEK V. NERIKAR D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 NW 138TH TER STE 200
JONESVILLE FL
32669-2091
US

IV. Provider business mailing address

4019 NW 17TH PL
GAINESVILLE FL
32605-3564
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-3080
  • Fax: 352-333-3729
Mailing address:
  • Phone: 904-553-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN14905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: