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General NPI Number Information
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NPI Number | 1457530651
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Entity Type | Individual
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Provider Name | NIDHI JAIN BDS, DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 2535 EAST BIDWELL, SUITE 150
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City | FOLSOM
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State | CA
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Zip | 95630
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Country | US
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Telephone | 916-984-1109
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Fax | 916-984-1764
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Provider Business Mailing Address
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Address Line | 9309 OFFICE PARK CIRCLE, SUITE 120
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City | ELK GROVE
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State | CA
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Zip | 95758
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Country | US
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Telephone | 916-691-1050
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Fax | 916-691-1066
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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 | 56089
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 56089
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License Number State | CA
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