Provider Demographics
NPI:1467006452
Name:NATHANI, AJAY KUMAR
Entity Type:Individual
Prefix:
First Name:AJAY KUMAR
Middle Name:
Last Name:NATHANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7473 HEDERA CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4227
Mailing Address - Country:US
Mailing Address - Phone:281-254-5798
Mailing Address - Fax:
Practice Address - Street 1:336 E HANES MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9135
Practice Address - Country:US
Practice Address - Phone:281-254-5798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist