Provider Demographics
NPI:1760816680
Name:NIJHAWAN, NIVEDITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIVEDITA
Middle Name:
Last Name:NIJHAWAN
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 1:1382 E ALLUVIAL AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2699
Mailing Address - Country:US
Mailing Address - Phone:559-224-1303
Mailing Address - Fax:559-225-3236
Practice Address - Street 1:1382 E ALLUVIAL AVE
Practice Address - Street 2:SUITE#104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2699
Practice Address - Country:US
Practice Address - Phone:559-224-1303
Practice Address - Fax:559-225-3236
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA628861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice