Provider Demographics
NPI:1013399799
Name:NIRVANA DENTAL
Entity Type:Organization
Organization Name:NIRVANA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:VARTIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-328-7403
Mailing Address - Street 1:3704 CHEEKSPARGER ROAD #100
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:352-328-7403
Mailing Address - Fax:
Practice Address - Street 1:3704 CHEEK SPARGER ROAD #100
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:352-328-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25677261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental