Provider Demographics
NPI:1235680539
Name:DR. NISS & DR. SHIFMAN, LLP
Entity Type:Organization
Organization Name:DR. NISS & DR. SHIFMAN, LLP
Other - Org Name:ABC FAMILY DENTAL & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NISS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-337-3300
Mailing Address - Street 1:1250 S SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80232-8022
Mailing Address - Country:US
Mailing Address - Phone:303-337-3300
Mailing Address - Fax:
Practice Address - Street 1:1250 S SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80232-8022
Practice Address - Country:US
Practice Address - Phone:303-337-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202968122300000X
CODEN.000103811223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty