Healthcare Provider Details

I. General information

NPI: 1285737072
Provider Name (Legal Business Name): SHIVA NIKAIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 HOLCOMB BRIDGE RD
ROSWELL GA
30076-1618
US

IV. Provider business mailing address

501 DUNWOODY CHACE NE
ATLANTA GA
30328-6007
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-2102
  • Fax: 770-441-0299
Mailing address:
  • Phone: 678-836-2102
  • Fax: 770-441-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: