Provider Demographics
NPI:1568835981
Name:NAND, SHIVAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIVAM
Middle Name:
Last Name:NAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6855 FAIR OAKS BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3365
Mailing Address - Country:US
Mailing Address - Phone:916-333-1875
Mailing Address - Fax:916-515-8663
Practice Address - Street 1:6855 FAIR OAKS BLVD STE 800
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3365
Practice Address - Country:US
Practice Address - Phone:916-333-1875
Practice Address - Fax:916-515-8663
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist