Provider Demographics
NPI:1093199432
Name:NANDA, VIKRUM (DMD, MS)
Entity Type:Individual
Prefix:
First Name:VIKRUM
Middle Name:
Last Name:NANDA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 OLDHAM CIR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-3739
Mailing Address - Country:US
Mailing Address - Phone:714-366-7390
Mailing Address - Fax:
Practice Address - Street 1:2540 OLDHAM CIR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-3739
Practice Address - Country:US
Practice Address - Phone:714-366-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics