MEDICARE: DR. NISHI H VAKHARIA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DD2296	NM

General Provider Information

NPI Number	:	1174540082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHI H VAKHARIA DDS

Provider Business Mailing Address
First Line	:	125 SIRINGO RD
Second Line	:	SUITE B
City	:	SANTA FE
State	:	NM
Zip	:	87505-5709
Country	:	US
Telephone Number	:	505-983-6153
Fax Number	:	505-983-8132

Provider Business Practice Location Address
First Line	:	125 SIRINGO RD
Second Line	:	SUITE B
City	:	SANTA FE
State	:	NM
Zip	:	87505-5709
Country	:	US
Telephone Number	:	505-983-6153
Fax Number	:	505-983-8132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/08/2007

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