Healthcare Provider Details

I. General information

NPI: 1497935704
Provider Name (Legal Business Name): NIRA DWIVEDI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 BELL BLVD SUITE 3
BAYSIDE NY
11361-2170
US

IV. Provider business mailing address

3808 BELL BLVD SUITE 3
BAYSIDE NY
11361-2170
US

V. Phone/Fax

Practice location:
  • Phone: 718-631-3300
  • Fax: 718-631-3309
Mailing address:
  • Phone: 718-631-3300
  • Fax: 718-631-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number049547-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: