Provider Demographics
NPI:1780278911
Name:BANGERA, NAINITA
Entity type:Individual
Prefix:
First Name:NAINITA
Middle Name:
Last Name:BANGERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 TROPEA WAY UNIT 1145
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8796
Mailing Address - Country:US
Mailing Address - Phone:612-756-5068
Mailing Address - Fax:
Practice Address - Street 1:10950 SAN JOSE BLVD STE 64
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6671
Practice Address - Country:US
Practice Address - Phone:904-260-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH28047124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist