Provider Demographics
NPI:1467474940
Name:NESHEIWAT, VICTOR OMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:OMAR
Last Name:NESHEIWAT
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 1:9 HUYLER DRIVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538
Mailing Address - Country:US
Mailing Address - Phone:917-686-9195
Mailing Address - Fax:
Practice Address - Street 1:2411 ROUTE 82
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:NY
Practice Address - Zip Code:12510-9800
Practice Address - Country:US
Practice Address - Phone:845-223-3966
Practice Address - Fax:845-223-7040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist