Provider Demographics
NPI:1750475224
Name:VIGNESWARAN, NADARAJAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:NADARAJAH
Middle Name:
Last Name:VIGNESWARAN
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:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:713-486-4410
Mailing Address - Fax:713-486-4416
Practice Address - Street 1:7500 CAMBRIDGE STREET
Practice Address - Street 2:5321
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-486-4410
Practice Address - Fax:713-486-4416
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206801223P0106X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190010074OtherRAILROAD MEDICARE
TX87D869OtherBLUE CROSS BLUE SHIELD
TXU69456Medicare UPIN
TX87D869OtherBLUE CROSS BLUE SHIELD