Healthcare Provider Details

I. General information

NPI: 1073091658
Provider Name (Legal Business Name): SAMIR J NAIK, DDSII, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 RIDDLE RD
DURHAM NC
27713-1294
US

IV. Provider business mailing address

9105 CLUB HILL DR
RALEIGH NC
27617-8433
US

V. Phone/Fax

Practice location:
  • Phone: 919-682-9707
  • Fax:
Mailing address:
  • Phone: 571-331-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number9478
License Number StateNC

VIII. Authorized Official

Name: DR. SAMIR J NAIK
Title or Position: PRESIDENT
Credential: DDS
Phone: 571-331-6962