Provider Demographics
NPI:1497230163
Name:GANATRA, NIDHI
Entity Type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:
Last Name:GANATRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 TRESSER BLVD UNIT 449
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3363
Mailing Address - Country:US
Mailing Address - Phone:914-525-6997
Mailing Address - Fax:
Practice Address - Street 1:75 TRESSER BLVD UNIT 449
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3363
Practice Address - Country:US
Practice Address - Phone:914-525-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00000000001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice