Provider Demographics
NPI:1568947042
Name:SIBAL, NIKHIL (DMD)
Entity Type:Individual
Prefix:
First Name:NIKHIL
Middle Name:
Last Name:SIBAL
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 1:3108 E PINTAIL WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8206
Mailing Address - Country:US
Mailing Address - Phone:857-707-2061
Mailing Address - Fax:
Practice Address - Street 1:WOODLAND FAMILY DENTAL
Practice Address - Street 2:58 W COURT STREET
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:857-707-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist