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General NPI Number Information
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NPI Number | 1639610538
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Entity Type | Organization
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Legal Business Name | NIRVANA CARE PLLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 15068 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3714
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Country | US
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Telephone | 210-494-7681
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Fax |
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Provider Business Mailing Address
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Address Line | 15068 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3714
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Country | US
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Telephone | 210-494-7681
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | VIRENDRASINH CHAUHAN
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Credential | DDS
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Telephone | 210-494-7681
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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 | 29133
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License Number State | TX
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