Provider Demographics
NPI:1083136295
Name:DARBANI, NIKKI (DDS)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:DARBANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HARTLEY RD
Mailing Address - Street 2:SUITE #210
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8206
Mailing Address - Country:US
Mailing Address - Phone:904-264-5437
Mailing Address - Fax:904-485-8417
Practice Address - Street 1:1584 KINGSLEY AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4502
Practice Address - Country:US
Practice Address - Phone:904-264-5437
Practice Address - Fax:904-485-8417
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry