Provider Demographics
NPI:1356957880
Name:BHORANIA, NISHA (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:NISHA
Middle Name:
Last Name:BHORANIA
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 N INTERSTATE 35 APT 1703
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2063
Mailing Address - Country:US
Mailing Address - Phone:630-408-9174
Mailing Address - Fax:
Practice Address - Street 1:6779 W STATE HIGHWAY 29 STE 200
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6977
Practice Address - Country:US
Practice Address - Phone:737-273-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190328161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice