Provider Demographics
NPI:1942721535
Name:KIAN NIKDEL DDS MSD PLLC
Entity Type:Organization
Organization Name:KIAN NIKDEL DDS MSD PLLC
Other - Org Name:LAKE JACKSON ROOT CANAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:832-762-5072
Mailing Address - Street 1:115 N DIXIE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5958
Mailing Address - Country:US
Mailing Address - Phone:979-297-0633
Mailing Address - Fax:
Practice Address - Street 1:115 N DIXIE DR STE 200
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5958
Practice Address - Country:US
Practice Address - Phone:979-236-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty