Healthcare Provider Details

I. General information

NPI: 1104639525
Provider Name (Legal Business Name): VARUN NISCHAL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WINCHESTER ST
KEENE NH
03431-3940
US

IV. Provider business mailing address

173 MONADNOCK HWY UNIT 218
SWANZEY NH
03446-2149
US

V. Phone/Fax

Practice location:
  • Phone: 603-522-7821
  • Fax:
Mailing address:
  • Phone: 781-647-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number05279
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: