Provider Demographics
NPI:1649287806
Name:RAO, NITHIN K (DDS)
Entity type:Individual
Prefix:DR
First Name:NITHIN
Middle Name:K
Last Name:RAO
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 1:2107 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4807
Mailing Address - Country:US
Mailing Address - Phone:716-839-2170
Mailing Address - Fax:716-839-2473
Practice Address - Street 1:2107 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4807
Practice Address - Country:US
Practice Address - Phone:716-839-2170
Practice Address - Fax:716-839-2473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526754003OtherBLUE CROSS AND BLUE SHIEL
NY1582057OtherUNITED CONCORDIA
NY02249392Medicaid
NY0016104OtherDORAL FIDELIS
NY4001532OtherINDEPENDENT HEALTH