Provider Demographics
NPI:1639617764
Name:NIKDEL, CATHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:
Last Name:NIKDEL
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 1:3814 ELKINS RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3260
Mailing Address - Country:US
Mailing Address - Phone:832-490-9341
Mailing Address - Fax:
Practice Address - Street 1:7500 CAMBRIDGE STREET, DEPARTMENT OF GENERAL PRACTICE
Practice Address - Street 2:UNIVERSITY OF TEXAS SCHOOL OF DENTISTRY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-486-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist