Provider Demographics
NPI:1083129183
Name:JIWANI, NELISHAH (DMD, CAGS)
Entity Type:Individual
Prefix:DR
First Name:NELISHAH
Middle Name:
Last Name:JIWANI
Suffix:
Gender:F
Credentials:DMD, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JODY CT
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2615
Mailing Address - Country:US
Mailing Address - Phone:415-429-9632
Mailing Address - Fax:
Practice Address - Street 1:809 CUESTA DR STE 205
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3666
Practice Address - Country:US
Practice Address - Phone:650-967-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist