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General NPI Number Information
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NPI Number | 1487047296
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Entity Type | Organization
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Legal Business Name | NIMISHA NIDGUNDI DDS INC.
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 1117 TASMAN DR
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City | SUNNYVALE
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State | CA
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Zip | 94089-2228
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Country | US
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Telephone | 408-234-0162
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Fax |
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Provider Business Mailing Address
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Address Line | 3575 LEHIGH DR APT 24
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City | SANTA CLARA
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State | CA
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Zip | 95051-6075
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Country | US
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Telephone | 408-234-0162
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | NIMISHA NIDGUNDI
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Credential |
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Telephone | 408-234-0162
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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 | 58682
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License Number State | CA
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