MEDICARE: ANGHITHA NIMIL 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	DN29063	FL

General Provider Information

NPI Number	:	1427890136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGHITHA NIMIL DDS

Provider Business Mailing Address
First Line	:	23871 US 27
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-7811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23871 US 27
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-7811
Country	:	US
Telephone Number	:	863-457-2691
Fax Number	:

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

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	02/12/2026

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