Healthcare Provider Details

I. General information

NPI: 1730809872
Provider Name (Legal Business Name): MR. DENZIL NAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 RUSTY SPUR DR
HENDERSON NV
89014-2576
US

IV. Provider business mailing address

5430 TUTT BLVD.
COLORADO SPRINGS CO
80922
US

V. Phone/Fax

Practice location:
  • Phone: 719-493-8762
  • Fax:
Mailing address:
  • Phone: 778-990-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8067
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00205247
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: