Provider Demographics
NPI:1922699222
Name:NIRVANA DENTAL, P.C.
Entity Type:Organization
Organization Name:NIRVANA DENTAL, P.C.
Other - Org Name:NIRVANA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YIJIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-540-1532
Mailing Address - Street 1:5 ELM ST APT 5
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2428
Mailing Address - Country:US
Mailing Address - Phone:857-540-1532
Mailing Address - Fax:
Practice Address - Street 1:285 CENTRAL ST STE 210
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-6144
Practice Address - Country:US
Practice Address - Phone:978-704-8788
Practice Address - Fax:978-798-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty