Provider Demographics
NPI:1073568820
Name:NAHAR, ANITA B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:B
Last Name:NAHAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:B
Other - Last Name:DUGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:900 UNIVERSITY BLVD N
Mailing Address - Street 2:MC - 75
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-9230
Mailing Address - Country:US
Mailing Address - Phone:904-253-2062
Mailing Address - Fax:904-253-1942
Practice Address - Street 1:1830 WEST 45TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208
Practice Address - Country:US
Practice Address - Phone:904-253-1783
Practice Address - Fax:904-253-1788
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172281223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0760871-00Medicaid
FL076087100Medicaid