Provider Demographics
NPI:1689838005
Name:NATHA, NISCHAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NISCHAL
Middle Name:
Last Name:NATHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 E LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7137
Mailing Address - Country:US
Mailing Address - Phone:702-641-5888
Mailing Address - Fax:702-633-0099
Practice Address - Street 1:2217 E LAKE MEAD BLVD # A
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7137
Practice Address - Country:US
Practice Address - Phone:702-641-5888
Practice Address - Fax:702-633-0099
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV66971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1689838005Medicaid