Healthcare Provider Details

I. General information

NPI: 1518580042
Provider Name (Legal Business Name): NIRANZENA PANNEER SELVAM M.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 CUMING STREET
OMAHA NE
68102
US

IV. Provider business mailing address

5325 S111TH PLAZA APT 201
OMAHA NE
68137
US

V. Phone/Fax

Practice location:
  • Phone: 804-585-5189
  • Fax:
Mailing address:
  • Phone: 804-585-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number36716
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number7889
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: