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General NPI Number Information
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NPI Number | 1184056855
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Entity Type | Individual
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Provider Name | NIKITA K PASTAGIA DDS
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Gender | Female
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 2107 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1122
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Country | US
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Telephone | 848-219-6039
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Fax |
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Provider Business Mailing Address
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Address Line | 2107 COTTMAN AVE.
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City | PHILADELPHIA
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State | PA
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Zip | 19149
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Country | US
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Telephone | 848-219-6039
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22D102544100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS039765
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License Number State | PA
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