Provider Demographics
NPI:1235506635
Name:JOSEPH T NISTA DDS PLLC
Entity Type:Organization
Organization Name:JOSEPH T NISTA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:NISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-435-0462
Mailing Address - Street 1:1035 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1225
Mailing Address - Country:US
Mailing Address - Phone:518-435-0462
Mailing Address - Fax:518-435-0487
Practice Address - Street 1:1035 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1225
Practice Address - Country:US
Practice Address - Phone:518-435-0462
Practice Address - Fax:518-435-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0401841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty