Provider Demographics
NPI:1265531677
Name:THAKKAR, NILESH S (DDS)
Entity type:Individual
Prefix:
First Name:NILESH
Middle Name:S
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 E NORTH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4064
Mailing Address - Country:US
Mailing Address - Phone:903-686-1897
Mailing Address - Fax:
Practice Address - Street 1:859 E NORTH CREEK DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-4064
Practice Address - Country:US
Practice Address - Phone:903-686-1897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5758015122300000X
TX29638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist