Provider Demographics
NPI:1497935704
Name:DWIVEDI, NIRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIRA
Middle Name:
Last Name:DWIVEDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 BELL BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2170
Mailing Address - Country:US
Mailing Address - Phone:718-631-3300
Mailing Address - Fax:718-631-3309
Practice Address - Street 1:3808 BELL BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2170
Practice Address - Country:US
Practice Address - Phone:718-631-3300
Practice Address - Fax:718-631-3309
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049547-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery