Provider Demographics
NPI:1407267974
Name:NIKTASH DENTAL CORPORATION
Entity Type:Organization
Organization Name:NIKTASH DENTAL CORPORATION
Other - Org Name:PARADISE DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOJGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKTASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-481-2121
Mailing Address - Street 1:31726 RANCHO VIEJO RD STE B-109
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2779
Mailing Address - Country:US
Mailing Address - Phone:949-481-2121
Mailing Address - Fax:949-218-7556
Practice Address - Street 1:31726 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2779
Practice Address - Country:US
Practice Address - Phone:949-481-1212
Practice Address - Fax:949-258-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty