Provider Demographics
NPI:1750475224
Name:VIGNESWARAN, NADARAJAH (DMD)
Entity type:Individual
Prefix:DR
First Name:NADARAJAH
Middle Name:
Last Name:VIGNESWARAN
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:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:713-486-4410
Mailing Address - Fax:713-486-4416
Practice Address - Street 1:7500 CAMBRIDGE STREET
Practice Address - Street 2:5321
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-486-4410
Practice Address - Fax:713-486-4416
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206801223P0106X, 1223S0112X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190010074OtherRAILROAD MEDICARE
TX87D869OtherBLUE CROSS BLUE SHIELD
TXU69456Medicare UPIN
TX87D869OtherBLUE CROSS BLUE SHIELD