Provider Demographics
NPI:1669504627
Name:NIKCHVICH, DONALD (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:NIKCHVICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 HAMPSHIRE RD
Mailing Address - Street 2:STE. 4
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2818
Mailing Address - Country:US
Mailing Address - Phone:805-495-7416
Mailing Address - Fax:805-495-7416
Practice Address - Street 1:911 HAMPSHIRE RD
Practice Address - Street 2:STE. 4
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2818
Practice Address - Country:US
Practice Address - Phone:805-495-7416
Practice Address - Fax:805-495-7416
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0361861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery