Provider Demographics
NPI:1710588488
Name:DALAL, NISHCHAL MUKESH (DDS)
Entity Type:Individual
Prefix:
First Name:NISHCHAL
Middle Name:MUKESH
Last Name:DALAL
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 1:12515 NATHANIEL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-1732
Mailing Address - Country:US
Mailing Address - Phone:703-300-8339
Mailing Address - Fax:
Practice Address - Street 1:2003 WOODBROOK CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1148
Practice Address - Country:US
Practice Address - Phone:434-975-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist