Provider Demographics
NPI:1770123515
Name:NIK, ELHAM (DDS)
Entity type:Individual
Prefix:
First Name:ELHAM
Middle Name:
Last Name:NIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 CURTIS CT APT B421
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-7482
Mailing Address - Country:US
Mailing Address - Phone:773-564-3333
Mailing Address - Fax:
Practice Address - Street 1:1009 N H ST STE P
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-8141
Practice Address - Country:US
Practice Address - Phone:805-214-4532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1047551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice