Provider Demographics
NPI:1922619071
Name:NEMMARUGOMMULA, NIKHILA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIKHILA
Middle Name:
Last Name:NEMMARUGOMMULA
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 1:4972 LARKENHEATH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0402
Mailing Address - Country:US
Mailing Address - Phone:516-606-4220
Mailing Address - Fax:
Practice Address - Street 1:4972 LARKENHEATH DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-0402
Practice Address - Country:US
Practice Address - Phone:516-606-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty