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General NPI Number Information
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NPI Number | 1063187904
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Entity Type | Individual
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Provider Name | NISHANTH DWAYEKATHVA SADHAK DDS
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Gender | Male
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 14 BISHOP RD
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City | BELMONT
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State | NH
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Zip | 03220-3110
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Country | US
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Telephone | 603-600-6361
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Fax |
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Provider Business Mailing Address
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Address Line | 13 ARBOR VIEW DR
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City | BALLSTON LAKE
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State | NY
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Zip | 12019-9336
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Country | US
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Telephone | 518-250-8535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 04677
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License Number State | NH
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