Provider Demographics
NPI:1144605478
Name:WAITS, NISHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:
Last Name:WAITS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3732
Mailing Address - Country:US
Mailing Address - Phone:615-593-9955
Mailing Address - Fax:
Practice Address - Street 1:1345 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3732
Practice Address - Country:US
Practice Address - Phone:615-593-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 213711223G0001X
TNDS00000102131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice