MEDICARE: DR. NISCHAL NATHA DMD

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	6697	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689838005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISCHAL NATHA DMD

Provider Business Mailing Address
First Line	:	2217 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7137
Country	:	US
Telephone Number	:	702-641-5888
Fax Number	:	702-633-0099

Provider Business Practice Location Address
First Line	:	2217 E LAKE MEAD BLVD # A
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7137
Country	:	US
Telephone Number	:	702-641-5888
Fax Number	:	702-633-0099

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	11/01/2019

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