Healthcare Provider Details

I. General information

NPI: 1922748300
Provider Name (Legal Business Name): NIKHIL MEHANDRU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BERGEN ST
NEWARK NJ
07103-2495
US

IV. Provider business mailing address

1 BERGEN ST APT 531
HARRISON NJ
07029-3205
US

V. Phone/Fax

Practice location:
  • Phone: 516-495-0093
  • Fax:
Mailing address:
  • Phone: 516-495-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number22DI02907401
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: