Healthcare Provider Details

I. General information

NPI: 1467594812
Provider Name (Legal Business Name): NILO M. NIKAIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 HIGHWAY 5
DOUGLASVILLE GA
30135-2384
US

IV. Provider business mailing address

657 DARLINGTON RD NE
ATLANTA GA
30305-2775
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-2111
  • Fax: 770-441-0299
Mailing address:
  • Phone: 404-846-0754
  • Fax: 770-441-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN012201
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: