Healthcare Provider Details

I. General information

NPI: 1700771086
Provider Name (Legal Business Name): NISHMA PINAKIN VIAS DDS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S PAULINA ST
CHICAGO IL
60612-7210
US

IV. Provider business mailing address

2605 HIGHGATE OAK DR
CARY NC
27519-7719
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number018.012623
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14231
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: