Provider Demographics
NPI:1275042723
Name:VASWANI, KANIKA (DMD)
Entity Type:Individual
Prefix:
First Name:KANIKA
Middle Name:
Last Name:VASWANI
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 1:651 SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1866
Mailing Address - Country:US
Mailing Address - Phone:781-289-3331
Mailing Address - Fax:
Practice Address - Street 1:651 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1866
Practice Address - Country:US
Practice Address - Phone:781-289-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADN1857757OtherMASSACHUSETTS DENTAL BOARDS