Provider Demographics
NPI:1417168030
Name:NISTA, GIRARD THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GIRARD
Middle Name:THOMAS
Last Name:NISTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2467
Mailing Address - Country:US
Mailing Address - Phone:603-778-8181
Mailing Address - Fax:603-772-4942
Practice Address - Street 1:89 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2467
Practice Address - Country:US
Practice Address - Phone:603-778-8181
Practice Address - Fax:603-772-4942
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1030OtherSTATE LICENSE