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General NPI Number Information
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NPI Number | 1356751481
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Entity Type | Individual
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Provider Name | NISHANT THAKKAR DDS
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Gender | Male
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 301 S MAIN RD
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City | VINELAND
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State | NJ
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Zip | 08360-7897
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Country | US
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Telephone | 856-691-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 221 E 33RD ST APT 3A
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City | NEW YORK
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State | NY
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Zip | 10016-9651
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Country | US
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Telephone | 212-960-3029
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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 | 22DI02598200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 058337
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1856819
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License Number State | MA
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