Provider Demographics
NPI:1003664426
Name:NAICKER, SHIVANESH (DMD)
Entity type:Individual
Prefix:DR
First Name:SHIVANESH
Middle Name:
Last Name:NAICKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2751
Mailing Address - Country:US
Mailing Address - Phone:650-922-8418
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 808
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-3910
Practice Address - Country:US
Practice Address - Phone:415-513-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist