Provider Demographics
NPI:1457530651
Name:JAIN, NIDHI (BDS, DMD, MS)
Entity type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:BDS, DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 OFFICE PARK CIRCLE, SUITE 120
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-691-1050
Mailing Address - Fax:916-691-1066
Practice Address - Street 1:2535 EAST BIDWELL, SUITE 150
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-984-1109
Practice Address - Fax:916-984-1764
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56089122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist