Provider Demographics
NPI:1992001291
Name:NIA ORTHODONTICS PA
Entity Type:Organization
Organization Name:NIA ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:NIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-744-6000
Mailing Address - Street 1:2621 RIDGEPOINT DR
Mailing Address - Street 2:130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5232
Mailing Address - Country:US
Mailing Address - Phone:512-583-9670
Mailing Address - Fax:512-334-2321
Practice Address - Street 1:6425 S IH 35
Practice Address - Street 2:100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4271
Practice Address - Country:US
Practice Address - Phone:512-744-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty